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Abstract: PO0117

Cause or Not: IgA-Dominant Infectious-Related Glomerulonephritis in a Patient Infected with COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Borrero-Arvelo, Alexander, Methodist Dallas Medical Center, Dallas, Texas, United States
  • Sebastian, Lisa M., Dallas Nephrology Associates, Dallas, Texas, United States
  • Collazo-Maldonado, Roberto L., Dallas Nephrology Associates, Dallas, Texas, United States
Introduction

IgA dominant infectious related glomerulonephritis (IGAD-IRGN) is an uncommon variant of IRGN. It has been mostly associated with S.aureus infections. In the COVID Era, thre has been one case of IGAD-IRGN related to COVID. This is a case of IGA-IRGN in a patient infected with COVID-19.

Case Description

51 y/o male with no previous medical history who presented with a 3 day history of generalized swelling. Patient had no known medical problems and was not taking any medications. He reported drinking 3 beers daily. Denied any recent illness or sick contacts. At ED, the patient was found with anasarca and uncontrolled blood pressure. Initial blood tests showed normal renal function with hypoalbuminemia (2.9g/dL). U/A showed active sediments and nephrotic range proteinuria of about 4 g/day. Proteinuria workup was done, including serologic workup. Labs were remarkable for elevated ESR (105), low C4 (12), normal C3 (95) and elevated RF (44). ANA, HIV, HCV, light chain ratio, cryoglobulins and ANCA were negative. UPIEP showed faint IgG kappa. CXR showed hazy interstitial opacities with a perihilar distribution. Pre-biopsy COVID molecular testing came back positive. . He was diuresed aggressively and received losartan for BP control. A kidney biopsy was performed and revealed MPGN pattern with IF strongly positive for IgA in addition to weaker staining for C3, and IgG. EM showed subendothelial humps with few mesangial and subepithelial deposits. The diagnosis of IgA-dominant immune complex-mediated glomerulonephritis consistent with IRGN was made.

Discussion

IGA-IRGN is a rare variant of IRGN that has been mostly associated with S. aureus infections. In this case, the recent COVID-19 infection in this patient could reasonably explain the finding of IGAD-IRGN on kidney biopsy. IGAD-COVID-related GN has been reported only once in the literature. Up until recently, most cases of COVID related kidney injury have been associated to ATN and collapsing FSGS. A immunohistochemistry test for COVID in kidney tissue was sent., which is pending at the time of this submission. If confirmed positive, this could be the second confirmed case COVID related IGAD-IRGN. It is important for nephrologists to include IGAD-IRGN in the differential diagnosis in a COVID patient with nephrotic syndrome. Renal Biopsy is of utmost importance for diagnosis.