Abstract: PO0106
Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposition (PGNMID) Associated with COVID-19
Session Information
- COVID-19: Health Systems and More
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Giannini, Julie, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
- Shieh, Michelle, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
- Combs, Sara, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
- Shaffi, Saeed Kamran, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
- Messias, Nidia Cordeiro, Arkana Laboratories, Little Rock, Arkansas, United States
- Teixeira, J Pedro, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
Introduction
Renal disease in COVID-19 is often due to acute tubular injury but can include multiple glomerular lesions such as collapsing glomerulopathy. This is the first reported case of COVID-19-associated PGNMID.
Case Description
A 71-year-old woman with normal baseline creatinine (Cr) was admitted with COVID-19 and discharged on oxygen and dexamethasone (Dex). She improved but returned a month later with edema and nausea. She was found to have nephrotic syndrome, hematuria, and AKI (peak Cr 8.5 mg/dL) requiring HD. Kidney biopsy revealed PGNMID with clonal IgG3-kappa. SPEP, serum free light chains (sFLC), 24h urine UPEP, bone marrow biopsy with flow cytometry, fat pad biopsy, and PET-CT were negative for monoclonal immunoglobulin (Ig) or cell line, amyloid, or malignancy. Though symptoms had long since resolved, she was still PCR-positive for SARS-CoV-2 on nasal swab. Upon discharge she was given cyclophosphamide (Cy). Her renal function improved (Cr 2.5) and she came off HD 2 weeks later. Her outpatient oncologist opted not to continue therapy. However, 2 months later she was readmitted with nausea, dyspnea, and anasarca with recurrent AKI (Cr 6.7) and nephrotic syndrome. HD was restarted. Repeat kidney biopsy [Figure] was noted to be a “carbon copy” of the first. SPEP, spot UPEP, and sFLC were again negative. She was started on Cy, bortezomib, and Dex with similar partial response (Cr <2.5).
Discussion
PGNMID is a rare type of monoclonal gammopathy of renal significance (MGRS) that often has no detectable extrarenal monoclonal Ig or cell line. MGRS and PGNMID, though usually not postinfectious, have been reported with other viruses (e.g., viral hepatitis, parvovirus-B19). However, though causality is unclear, this is the first case of MGRS reported in association with COVID-19.
Biopsy #2 yielded 32 glomeruli, 4 globally sclerotic, 4 with crescents, and rest with highly active proliferative GN (panel A, H&E 400x), with 20% interstitial fibrosis. IF showed granular deposition restricted to IgG3-kappa (panel B, IgG3 stain 400x).