Clinical and pathological findings of SARS-CoV-2 infection and concurrent IgA nephropathy: a case report
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CASE REPORT
Open Access
Clinical and pathological findings of SARSCoV-2 infection and concurrent IgA nephropathy: a case report Yi Huang1, Xiao-Juan Li1, Yue-Qiang Li1, Wei Dai1, Tiffany Shao2, Wei-Yong Liu3, Min Han1, Gang Xu1 and Liu Liu1*
Abstract Background: Since the Coronavirus Disease 2019 (COVID-19) outbreak, there is accumulating data on the clinical characteristics, treatment strategies and prognosis of COVID-19 in patients with concurrent renal disease. Postmortem investigations reveal renal involvement in COVID-19, and most recently, several biopsy researches reveal that acute tubular injury, as well as glomerular nephropathy such as collapsing glomerulopathy were common histological findings. However, to our best knowledge, there is limited data regarding IgA nephropathy in the setting of COVID-19. Case presentation: In the present case, we report a 65-year old Chinese woman who presented with dark-colored urine, worsening proteinuria and decreased renal function after COVID-19 infection. She received a renal biopsy during COVID-19 infection. The renal biopsy revealed IgA nephropathy without any evidence for SARS-Cov-2. The findings suggest that the renal abnormalities were a consequence of exacerbation of this patient’s underlying glomerular disease after COVID-19 infection. After a regimen of 3-day course of glucocorticoid and angiotensin II receptor blocker therapy, the patient recovered and remained stable upon follow-up. Conclusions: It is important to consider the underlying glomerular disease exacerbation as well as virus induced injury when dealing with renal abnormalities in patients with COVID-19. A kidney biopsy may be indicated to exclude a rapidly progressive glomerular disease. Keywords: COVID-19, IgA nephropathy, Case report, Macroscopic hematuria, Acute kidney injury
Background The Coronavirus Disease 2019 (COVID-19) is an emerging infectious disease attributed to the infection by a novel coronavirus termed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) [1]. Chronic kidney disease (CKD) that accounts for 0.7–2.9% of the investigated population is not a frequent underlying condition in patients with COVID-19 [2–4]. Patients in older age * Correspondence: [email protected] 1 Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, Hubei, P.R. China Full list of author information is available at the end of the article
and with comorbidities such as hypertension are at a higher risk to progress. Currently, there is no robust evidence to indicate that patients with CKD are at an increased risk compared with other comorbidities. To date, publications linking COVID-19 with renal comorbidities are mostly focused on patients with end-stage renal disease [5, 6]. IgA nephropathy is the most common primary glomerular disease [7], and the impact of COVID-19 on patients with glomerular diseases has not been studied. In the current report, we present the clinical course and histological
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