This is the biopsy from a 41yo Middle Eastern female who received a renal transplant a few years prior and presents with AKI. What is your diagnosis?
The biopsy shows collapsing glomerulopathy, for which the differential diagnosis in a transplant recipient includes ischemia, calcineurin inhibitor nephrotoxicity, CMV infection, thrombotic microangiopathy, and donor-derived APOL1-associated nephropathy. The patient reported mild COVID19 infection two weeks prior to presentation, not requiring hospitalization. Although the donor APOL1 status is unknown, it is likely that it was a carrier of APOL1 high risk alleles, and COVID19 infection was the second hit that triggered the development of collapsing glomerulopathy in the recipient.
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