Lessons for the clinical nephrologist: recurrence of nephrotic syndrome induced by SARS-CoV-2

Language
en
Document Type
Article
Issue Date
2023-05-22
First published
2020-12-01
Issue Year
2020
Authors
Doevelaar, Adrian A. N.
Hölzer, Bodo
Seibert, Felix S.
Bauer, Frederic
Stervbo, Ulrik
Rohn, Benjamin J.
Zgoura, Panagiota
Schenker, Peter
Vonbrunn, Eva
Amann, Kerstin
Editor
Publisher
Springer International Publishing
Abstract

Abstract 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.

Journal Title
Journal of Nephrology
Volume
33
Issue
6
Citation
Journal of Nephrology 33.6 (2020): S. 1369-1372. <https://link.springer.com/article/10.1007/s40620-020-00855-5>
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