Lessons for the clinical nephrologist: recurrence of nephrotic syndrome induced by SARS-CoV-2.
Adrian A N DoevelaarBodo HölzerFelix S SeibertFrederic BauerUlrik StervboBenjamin J RohnPanagiota ZgouraPeter SchenkerEva VonbrunnKerstin AmannRichard ViebahnNina BabelTimm Henning WesthoffPublished in: Journal of nephrology (2020)
SARS-CoV-2 is characterized by a multiorgan tropism including the kidneys. Recent autopsy series indicated that SARS-CoV-2 can infect both tubular and glomerular cells. Whereas tubular cell infiltration may contribute to acute kidney injury, data on a potential clinical correlative to glomerular affection is rare. We describe the first case of nephrotic syndrome in the context of COVID-19 in a renal transplant recipient. A 35 year old male patient received a kidney allograft for primary focal segmental glomerulosclerosis (FSGS). Three months posttransplant a recurrence of podocytopathy was successfully managed by plasma exchange, ivIG, and a conversion from tacrolimus to belatacept (initial proteinuria > 6 g/l decreased to 169 mg/l). Six weeks later he was tested positive for SARS-CoV-2 and developed a second increase of proteinuria (5.6 g/l). Renal allograft biopsy revealed diffuse podocyte effacement and was positive for SARS-CoV-2 in RNA in-situ hybridation indicating a SARS-CoV-2 associated recurrence of podocytopathy. Noteworthy, nephrotic proteinuria resolved spontaneously after recovering from COVID-19. The present case expands the spectrum of renal involvement in COVID-19 from acute tubular injury to podocytopathy in renal transplant recipients. Thus, it may be wise to test for SARS-CoV-2 prior to initiation of immunosuppression in new onset glomerulopathy during the pandemic.
Keyphrases
- sars cov
- respiratory syndrome coronavirus
- acute kidney injury
- high glucose
- stem cells
- coronavirus disease
- induced apoptosis
- intensive care unit
- cardiac surgery
- oxidative stress
- mesenchymal stem cells
- electronic health record
- liver failure
- free survival
- human health
- extracorporeal membrane oxygenation
- kidney transplantation
- climate change
- cell therapy
- aortic dissection