ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

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

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).