Most patients with Covid-19 and AKI have been found to have ATN on kidney biopsy. However, there have been increasing reports of collapsing glomerulopathy in patients with Covid-19 aka COVAN. Most of the patients only had mild respiratory symptoms. They presented with AKI, nephrotic-range proteinuria and hypoalbuminemia. All the patients were of Black ethnicity and had high risk APOL1 gene variants, as seen in HIVAN.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196556/

Well!

There is direct and indirect involvement of the kidney by COVID 19 infection.

Acute kidney injury is a well known with proteinuria and rising creatinine.

There is still alot to understand by utilizing histological with various technique examinations.

It all depends on the resources but biopsy is always a good standard of care to understand what is going on with this new infection.

However, will it impact on patient care or not is the main question that must be addresed by the clinicians. Or is it just purely an academic aspect to further enhance our understanding of the pathophysiology mechanism.

Although ATN is the most likely pathology identified in COVID patients, other important considerations cannot be confirmed without biopsy as in TMA although can be suspected clinically.

Complement activation has been identified in early as well as in late COVID cases. In this case, consideration of PLEX or complement targeted therapy

Dear colleagues,

I believe that the diagnose of ATN can be adequately performed by the association of urinalysis + dosage of blood urea nitrogen and creatine + measures of sodium + CT scans. Biopsy might prompt to a higher harm effect rather than higher benefits.

Thanks for putting this question available for discussion.