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Kidney Week

Abstract: PO0124

COVID-19-Induced P-ANCA-Associated Nephritic Syndrome in a Woman Without Respiratory Involvement

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Rosaly, Jan P., Mayaguez Medical Center, Mayaguez, Puerto Rico
  • Pabon-Vazquez, Elizabeth, Mayaguez Medical Center, Mayaguez, Puerto Rico
  • Pagan rivera, Bryan L., Mayaguez Medical Center, Mayaguez, Puerto Rico
Introduction

Infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has affected our population worldwide leading to a global pandemic.The most common manifestation was infection to the lungs leading to respiratory failure.As the infection continued to spread, other complications started to emerge.Studies have identified involvement of other organs such as heart and kidneys.It has been observed that patients with severe infection are debuting with renal failure.The most common lesion is acute tubular necrosis (ATN) but other causes such as endotheliitis, nephrotic syndrome and glomerulonephritis (GN) have been observed.ANCA associated GN is a rare manifestation of SARS-CoV-2 infection that must be differentiated from ATN.Only two cases of ANCA associated vasculitis have been reported.They were both male and presented with ANCA associated GN responsive to immunosuppressive therapy.

Case Description

Case of a 65 year old female patient with medical history of asthma and dyslipidemia presented to the hospital with complaints of recurrent painless hematuria.Physical examination was unremarkable.Initial laboratory work up was remarkable for acute kidney injury accompanied by the presence of pyuria, hematuria and proteinuria.There was evidence of leukocytosis and anemia.PCR test for COVID19 came back positive.Renal imaging showed thickening of the urothelium at the renal pelvis with parenchymal echogenicity.After multiple efforts there was no significant improvement.Hence, work-up to exclude nephritic syndrome was requested.Reports were remarkable for positive p-ANCA and presence of MPO antibodies.Workup for GBM antibodies came back negative.Patient was started on intravenous steroids. Renal biopsy showed evidence of ANCA mediated pauci immune GN with crescents.Further on, she was transitioned to oral steroids and Rituxan where improvement of renal function was observed.

Discussion

While ANCA associated GN in SARS-CoV-2 is rare, the incidence of COVID19 cases is on the rise.The incidence of other potential complications are yet to be identified.Thus, it is important to understand and study the disease’s pathophysiology to extrapolate possible complications.This will assist in the early detection of disease and help improve patient's prognosis.Also, will prevent development of chronic repercussions in patient’s renal function.