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  • We report a case of a kidney transplant recipient who presented with acute kidney injury and nephrotic-range proteinuria in a context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Kidney biopsy revealed collapsing glomerulopathy. Droplet-based digital PCR did not detect the presence of SARS-CoV-2 RNA in the biopsy fragment, and the virus was barely detectable in the plasma at the time of the biopsy. SARS-CoV-2 RNAemia peaked several days later, followed by a seroconversion despite the absence of circulating CD19-positive lymphocytes at admission due to rituximab-based treatment of antibody-mediated rejection 3 months earlier. Genotyping for the two risk alleles of the apolipoprotein L1 (APOL1) gene revealed that the donor carried the low-risk G0/G2 genotype. This case illustrates that COVID-19 may promote a collapsing glomerulopathy in kidney allografts with a low-risk APOL1 genotype, in the absence of detectable SARS-CoV2 RNA in the kidney, and that podocyte injury may precede SARS-CoV2 RNAemia.
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