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Abstract: PO0116

Tip Lesion Variant of Focal and Segmental Glomerulosclerosis (FSGS): A Case Report in a Patient with COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Afonso, Rita Serra, Centro Hospitalar do Algarve EPE, Faro, Faro, Portugal
  • Cabrita, Ana, Centro Hospitalar do Algarve EPE, Faro, Faro, Portugal
  • Silva, Ana Paula, Centro Hospitalar do Algarve EPE, Faro, Faro, Portugal
Introduction

Acute kidney injury (AKI) is a common complication of SARS-CoV-2 infection. Published cases report acute tubular injury as the most common pathologic finding in these patients. Glomerular disease has been reported in a minority of patients, with collapsing focal segmental glomerulosclerosis being the most common. Nonetheless, the existing evidence is sparse and inconclusive. The authors present a case of a patient diagnosed with a tip lesion variant of focal and segmental glomerulosclerosis (FSGS) and concomitant SARS-CoV-2 infection.

Case Description

A 43-year-old African woman, with no known past medical history, presented to the emergency department with a 6-day history of fatigue, headache, cough, hypoageusia, myalgia, dyspnea, nausea and vomiting. Laboratory tests confirmed SARS-CoV-2 infection. Despite fluid therapy, there was an elevation of serum creatinine from 1.1 to 1.6mg/dl and the urinalysis was positive for protein (4 ) and blood (2 ). The urinary sediment revealed 3 red blood cells per high-power field. The urinary protein/creatinine ratio was approximately 13 g, subsequently confirmed with a 24-hour urine collection (13445 mg/24hours). All immunological tests were negative with the exception of hepatitis B serology (positive for HBV past infection). Renal ultrasonography showed a right kidney of 106 mm and a left kidney measuring 99 mm with important reduction of corticomedullary differentiation. After cure criteria for COVID-19, the proteinuria was 1022 mg/24h. The kidney biopsy revealed a tip lesion variant of focal and segmental glomerulosclerosis (FSGS). Low dose angiotensin converting enzyme inhibitors were started but no corticotherapy due to spontaneous regression of proteinuria. The patient returned home 20 days after hospitalisation. After 1 month, serum creatinine levels and 24-hour urine protein decreased to 1.1 mg/dl and 1060 mg, respectively.

Discussion

To our knowledge, this is the first case report of a patient with tip lesion variant of focal and segmental glomerulosclerosis (FSGS) possibly associated with COVID-19 disease. More data from kidney biopsies will further elucidate about pathologic processes associated with kidney injury and glomerular involvement in SARS-CoV2 infection.