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Abstract: PO1414

Catastrophic COVID-19-Associated Nephropathy (COVAN) in an Asymptomatic Patient

Session Information

Category: Glomerular Diseases

  • 1201 Glomerular Diseases: Fibrosis and Extracellular Matrix

Authors

  • Akrawi, Samer, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Sabbouh, Toni, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Janom, Khaled, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Rao, Panduranga S., University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Lapedis, Cathryn Jane, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
Introduction

Glomerular lesions were reported in a minority of patients with COVID-19, with collapsing focal segmental glomerulosclerosis (FSGS) also called COVID-associated nephropathy (COVAN), This typically occurs in the setting of prominent COVID symptoms. We describe a COVAN occurring in an asymptomatic patient

Case Description

A 48-year-old, African American female patient who had CKD stage 3 a secondary to hypertension, with serum creatinine of 1.2 mg/dl and absent proteinuria at baseline, presented to the hospital for evaluation of an asymptomatic elevation of her serum creatinine to 9.9 mg/dl, discovered during a routine evaluation by her PCP. Her urine Protein/Creatinine was 6.15.
Six weeks prior to her presentation, she endorsed 7 days of nausea and intermittent vomiting associated with non-bloody diarrhea without respiratory symptoms. Her GI symptoms has resolved on its own. She had multiple family members, including her husband and daughter, who had tested positive for COVID around the same time. Her nasal PCR for COVID was negative. She had not been vaccinated for SARS COVID.
She has no family history of kidney disease; she denied IV drug use and had no risk factors for HIV. She was on Amlodipine for her hypertension. She was afebrile on admission with blood pressure of 170/80 mm Hg. She had 1+ pedal edema with an unremarkable physical exam. A percutaneous kidney biopsy was performed to evaluate the cause of her renal dysfunction. This showed collapsing FSGS. HIV and ANA were negative. A subsequent testing for COVID nucleocapsid and spike protein was positive. Results of APOL1 genotype is pending. She was started on high dose steroids and followed up as an outpatient.

Discussion

COVAN is increasing recognized as a serious complication of COVID. However, the typical presentation is in the setting of prominent respiratory involvement. Recognizing the minor fleeting symptoms of COVID preceding a catastrophic kidney disease and testing for it is an important in patients presenting with features of collapsing FSGS