Abstract: PO1481
Does SARS-CoV-2 Activate the Alternative Complement Pathway? A Case Report of C3-Dominant Proliferative GN in a Patient with SARS-CoV-2 Infection
Session Information
- Glomerular Diseases: The Excitement of Clinical Cases
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1202 Glomerular Diseases: Immunology and Inflammation
Authors
- Khan, Jahanzeb, Baptist Health Medical Center - North Little Rock, North Little Rock, Arkansas, United States
- Bukhari, Sehrish W., Kidney Care Center, Little Rock, Arkansas, United States
- Alam, Muhammad G., Baptist Health Medical Center - North Little Rock, North Little Rock, Arkansas, United States
Introduction
C3-glomerulopathy is a rare kidney disorder due to dysregulation of the alternative complement pathway. C3 glomerulonephritis (C3GN) has been associated with a variety of diseases including connective tissue disorders and infections. Here we present the first case report of C3GN in a patient with SARS-CoV-2 infection.
Case Description
A 54-year-old man with no known renal disease presented to the hospital with fever, cough, dyspnea and worsening edema. His SARS-CoV2 PCR test was positive and he was treated for COVID-19 pneumonia. His blood cultures remained negative and no bacterial infection was identified. He was also noted to have worsening renal function with a peak serum creatinine of 3.9 mg/dL. His serologies including Hep B, Hep C, HIV, ANA, ANCA, RF, and Cryoglobulins were all negative. His serum complement levels were low. A renal biopsy was performed. Light microscopy showed mild mesangial and endocapillary hypercellularity (Figure A). IF revealed mesangial and endocapillary wall staining positive for C3. Electron microscopy confirmed electron dense deposits of C3 (Figure B).
Discussion
Several mechanisms have been suggested in the pathogenesis of SARS-CoV-2 related tissue injury including classical and alternate compliment pathways. C3GN is rare renal disorder due to dysregulation of alternate complement pathway. C3GN is characterized by mesangial deposits, endocapillary hypercellularity under light microscopy, and C3 deposits in mesangial and endocapillary wall on IF, in the absence of other significant findings. We present the first case report of C3GN in a patient with SARS- CoV-2 infection. Although this case does not establish a cause-effect relationship, but does raise the possibility of activation of the alternative complement pathway in SARS-COV-2 infection.
Light microscopy showed mild mesangial and endocapillary hypercellularity (Figure A). Electron microscopy confirmed electron dense deposits of C3 (Figure B).