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Abstract: PO1617

A Rare Case of Crescentic Glomerulonephritis, Diffuse Proliferative Class IV Lupus Nephritis, and Collapsing Glomerulopathy in a COVID, P-ANCA, and Myeloperoxidase-Positive Patient

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Ganglam, Ajay Bhasker Rao, Albert Einstein Medical Center, Philadelphia, Pennsylvania, United States
  • Batool, Fatima, Albert Einstein Medical Center, Philadelphia, Pennsylvania, United States
  • Miick, Ronald, Albert Einstein Medical Center, Philadelphia, Pennsylvania, United States
  • Chewaproug, Daranee, Albert Einstein Medical Center, Philadelphia, Pennsylvania, United States
  • Pedroza, Mauricio Alexander, Albert Einstein Medical Center, Philadelphia, Pennsylvania, United States
Introduction

An unusual case of Diffuse Class 4 Lupus Nephritis, along with Collapsing Glomerulopathy from asymptomatic COVID infection

Case Description

42 year old Asian female presented with painless hematuria, anasarca, reduced hearing, and eye redness over a month. She had empiric antibiotics and steroids prior to admission. On admission, she was hypertensive with anasarca. Labs revealed AKI creatinine of 2.5 mg/dl, proteinuria of 11 grams, and serum albumin 1.9 gm/dL. Urine analysis showed dysmorphic RBCs, RBC casts. Ultrasound showed 12 cm kidneys bilaterally. She had normal complements and DS DNA, anticardiolipin and lupus anticoagulant negative. ANA, anticentromere antibody, COVID, PANCA, MPO all positive. Kidney biopsy showed crescentic glomerulonephritis, diffuse proliferative glomerulonephritis Class IV, collapsing glomerulopathy, full house pattern on IF. EM showed sub endothelial, mesangial, and para mesangial deposits, diffuse podocyte foot process effacement, corona virions in endothelial cells. The patient did not have any COVID symptoms and was treated with pulse steroids, MMF induction, hydroxychloroquine, and ACE I. Serum creatinine improved to 1.33 mg/dl, proteinuria improved to 5.6 grams. Her eye redness and hearing impairment resolved.

Discussion

This is a rare case of diffuse class IV lupus nephritis with normal complements, DS DNA, and full house pattern on IF. She tested positive for COVID, was asymptomatic, and was able to start treatment. Corona virions and podocytopathy was noted on EM. Improvement in proteinuria, serum creatinine, albumin, and resolution of anasarca were used to monitor response to treatments. Complements and DS DNA could not monitor disease activity. Thus, clinicians should not rely purely on serologies for diagnosis but should pursue kidney biopsy for definitive diagnosis and treatment. Patients may have atypical presentations.