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Abstract: PO0112

IgA Vasculitis with Renal Manifestations in a College-Aged Individual After COVID-19 Infection

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Lazoff, Samuel A., University of Virginia, Charlottesville, Virginia, United States
  • Chopra, Tushar, University of Virginia, Charlottesville, Virginia, United States
  • Abdel-Rahman, Emaad M., University of Virginia, Charlottesville, Virginia, United States
Introduction

IgA Vasculitis is one of the most common causes of primary glomerulonephritis, however there are very few cases reported in association with COVID-19. Approximately 20-50% of patients present with renal manifestations, such as IgA Nephropathy (IgAN). Here we present a case of rapidly progressing crescentic IgAN presenting after COVID-19 infection.

Case Description

A 19-year-old male presented to the emergency department with elevated creatinine after being seen in the rheumatology clinic. A timeline of the patient's symptoms is presented in Figure 1. The renal biopsy showed a rapidly progressing IgAN with 15% crescents, hence he was placed on Mycophenolate mofetil and prednisone. He was also placed on Lisinopril and low-salt diet for better control of blood pressure and fish oil for dyslipidemia. Despite aggressive immunosuppression and risk factor modification, his renal function has not improved and he continues to have nephrotic range proteinuria.

Discussion

COVID-19 is a coronavirus that enters the host cell via the ACE-2 receptor. In the kidney, ACE-2 is expressed in mesangial cells, podocytes, the parietal epithelium of Bowman's capsule, and the collecting ducts. Research suggests that the inflammatory environment from COVID-19 can activate or exacerbate immune mediated diseases in predisposed individuals. The mucosal immune response against COVID-19 might have contributed to the progression of IgAN in this patient. We plan on checking the SARS-CoV-2 anti-RBD IgA titer to see if there is a correlation between anti-RBD IgA levels and progression of kidney function. Also, the persistence of IgA antibody or memory B cells post-COVID 19 infections may have prognostic implications in advancing IgAN or even end-stage kidney disease. Although our patient has not been vaccinated, there have also been cases of patients with IgAN developing gross hematuria after receiving the mRNA COVID-19 vaccine. This suggests that the vaccine components may induce further activation of disease. This previously healthy patient is believed to have a severe and persistent case of IgAN in part due to his COVID-19 infection.