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Background and Aims COVID-19 infection is responsible for respiratory infection with variable clinical expression from its asymptomatic form to severe pneumonia associated with acute respiratory distress syndrome and death. Risk factors related to higher mortality are age over 65 years, cardiovascular, pulmonary and kidney disease, hypertension, and diabetes. There is limited scientific literature on COVID-19 infection and previous kidney disease, specifically in patients with glomerular and tubular kidney disease. The aim of this study was to determine general characteristics, analytical parameters and clinical evolution of patients with kidney disease who have undergone kidney biopsy and who presented infection or high suspicion of infection by COVID-19. Identify mortality and associated risk factors. Method we studied patients with high clinical suspicion of infection or confirmed infection by COVID-19 from March 2020 to May 15, 2020 of all patients who underwent percutaneous renal biopsy at the Vall d'Hebron Hospital between January 2013 and December 2019. Results 39 of the 553 patients have been diagnosed with COVID-19 infection since March 2020. The average age was 63±15 years and 48.7% were male. Hypertension was present in 79.5% of patients, chronic kidney disease without renal replacement therapy in 76.9%, and cardiovascular disease in 64.1%. Nasopharyngeal swab was performed in 26 patients; older patients (p=0.01), patients with hypertension (p=0.005), immunosuppression (p=0.01), use of RAS-blocking drugs (p=0.04) and gastrointestinal symptoms (p=0.02) were more likely to be tested for COVID-19. 22 patients required hospitalization and 15.4% died. In the bivariate analysis, mortality was associated with older age (p=0.03), cardiovascular disease (p=0.05), chronic obstructive pulmonary disease (COPD) (p=0.05) and low hemoglobin levels (p=0.006). Adjusted Cox regression showed that low hemoglobin levels (10.12±1.89g/dL) at admission had 1.81 greater risk of mortality [1.04-3.13; p=0.04]. Conclusion Patients with COVID-19 infection and kidney disease confirmed by kidney biopsy presented mortality of 15.4%. Swab test for COVID-19 was more likely to be performed in older, hypertensive, use of RAS-blocking drugs, immunosuppressed patients and those with gastrointestinal symptoms. Low hemoglobin is a risk factor for mortality.

Background and Aims IgA nephropathy (IgAN) is the most common glomerulonephritis. The presence of ANCAs in this pathology represents a rare coincidence. However, it is not clear if the presence of IgA or IgG ANCAs in these patients could have clinical significance. We aim to describe the presence of IgA and IgG ANCAs in patients diagnosed with IgAN with crescents, and its possible clinical implications. Method Retrospective study from 2013 to 2020, it included all patients diagnosed by kidney biopsy of IgAN with extracapillary proliferation. Outpatient follow-up time was up to 24 months. Demographics and clinicopathologic data, ANCAs subtype, characteristics of the biopsy and treatment at the time of diagnosis/follow up was recollected. Results From 2013 to 2020, 17 adults were diagnosed with IgAN and extracapillary proliferation. 5 patients presented ANCAs, 3 (17%) were IgA ANCAs and 2 (11%) were IgG ANCAs. At diagnosis, the median age was 48 years old (27-75 years, sd. 15), with 9 women (52%). At the time of diagnosis, the most common clinical presentation was hypertension (71%). The laboratory analysis showed that median hemoglobin was 11.7 mg/dl (8.4-14.9 mg/dL, sd. 1.5), median creatinine was 2.2 mg/dL (0.55-5.7 mg/dL, sd. 1.4) and median proteinuria was 3.5 g/mgCr (0.1-12 g/mgCr, sd. 3.5). 7 patients (41%) presented extracapillary proliferation less than 25%, 7 patients presented it between 25% and 50%, and 3 patients (17%) had it in more than 50%. 5 (30%) patients presented fibrinoid necrosis. 1 (6%) patient needed renal replacement therapy upon admission. In terms of treatment, all patients with ANCAs IgAN received endovenous steroids and cyclophosphamide. The mean follow-up time was 6 months. Oral steroids (59%) and mycophenolate (41%) were the most frequent treatments. At six months, the median creatinine was 1.9 mg/dL (0.4-7, sd. 1.78) and the median proteinuria was 1.45 g/gCr (0.12-5.9, sd. 1.84 g/gCr). 3 patients developed end-stage chronic kidney disease and requiring substitute renal therapy; 4 patients died. Statistical analysis did not show differences in clinical characteristics, demographics, kidney function, proteinuria, need for renal therapy replacement or mortality according to the presence or subtype of ANCA. ANCA negative patients presented less than 25% of extracapillary proliferation in renal biopsy (p = 0.04). ANCA positive patients presented more fibrinoid necrosis than ANCA negative patients (p=0.01). Conclusion Given the limited size of our sample, our results do not allow us to be conclusive, showing no significant differences between the ANCA subtypes. However, from the point of renal biopsy, it is observed that patients with negative ANCAs present less extracapillary proliferation; and that patients ANCA positive presented more fibrinoid necrosis.

Introduction: Chronic kidney disease (CKD) patients infected with COVID-19 are at risk of serious complications such as hospitalization and death. The prognosis and lethality of COVID-19 infection in patients with established kidney disease has not been widely studied. Methods: Data included patients who underwent kidney biopsy at the Vall d’Hebron Hospital between January 2013 and February 2020 with COVID-19 diagnosis during the period from March 1 to May 15, 2020. Results: Thirty-nine (7%) patients were diagnosed with COVID-19 infection. Mean age was 63 ± 15 years and 48.7% were male. Hypertension was present in 79.5%, CKD without renal replacement therapy in 76.9%, and cardiovascular disease in 64.1%. Nasopharyngeal swab was performed in 26 patients; older (p = 0.01), hypertensive (p = 0.005), and immunosuppressed (p = 0.01) patients, those using RAS-blocking drugs (p = 0.04), and those with gastrointestinal symptoms (p = 0.02) were more likely to be tested for CO­VID-19. Twenty-two patients required hospitalization and 15.4% died. In bivariate analysis, mortality was associated with older age (p = 0.03), cardiovascular disease (p = 0.05), chronic obstructive pulmonary disease (p = 0.05), and low hemoglobin levels (p = 0.006). Adjusted Cox regression showed that low hemoglobin levels at admission had 1.81 greater risk of mortality. Conclusions: Patients with CO­VID-19 infection and kidney disease confirmed by kidney biopsy presented a mortality of 15.4%. Swab test for COVID-19 was more likely to be performed in older, hypertensive, and immunosuppressed patients, those using RAS-blocking drugs, and those with gastrointestinal symptoms. Low hemoglobin is a risk factor for mortality.