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Abstract: FR-PO040

Mixed Nephrotic/Nephritic Syndrome in a Pediatric Patient With SARS-CoV-2 Infection

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Glenn Lecea, Eva M., Nicklaus Children's Hospital, Miami, Florida, United States
  • Torres Nunez, Marleni Regalada, Nicklaus Children's Hospital, Miami, Florida, United States
  • Paredes, Ana L., Kidz Medical, Miami, Florida, United States
Introduction

Glomerular diseases in children generally present as a variety of findings that include hematuria, proteinuria, edema, and hypertension. Glomerular diseases can be isolated to the kidney or present as a component of a systemic disorder. Emerging reports show that SARS-CoV-2 infection precedes the appearance of various autoimmune diseases.

Case Description

Twelve-year-old Hispanic female with history of migraines, obesity, hypercholesterolemia, and NAFLD, who presented with anasarca, fever, and fatigue. On exam, she had hypertension (138/89 mmHg) and anasarca with ascites. Labwork was remarkable for K+ 5.6 mmol/L, Cr 1.07 mg/dL, albumin 2.1 gm/dL, AST 48 IU/L, cholesterol 265 mg/dL, triglycerides 178 mg/dL, CRP 2.6 mg/dL and ESR 80 mm/hr. UA with >500 proteinuria, moderate blood, 100 RBCs, 49 WBCs, and negative leukocyte esterase and nitrites. A rapid strep test and Hepatitis Panel were negative. ANA <1:10, C3 complement level low at 36 mg/dL, C4 normal. Abdominal US showed hepatomegaly, echogenic bilateral kidneys, and a small pleural effusion. SARS-CoV2 antigen test was positive. She was managed with antihypertensives, albumin infusions, and furosemide. She was readmitted 2 weeks later from the Nephrology clinic since her creatinine was 1.5 mg/dL and she persisted with generalized edema. Repeat SARS-CoV2 PCR was negative. At this time, she presented ANA titer in ≥1:1280, strongly positive SSA, SSB, and SM antibodies, low C3 (43.0 mg/dL) and low C4 (7.4 mg/dL). Renal biopsy specimens showed more than 50 percent of glomeruli affected with mesangial and extracapillary hypercellularity, segmental cellular crescents, interstitial fibrosis, and marked deposition of immunoglobulins and complement, consistent with lupus nephritis Grade IV.

Discussion

Systemic Lupus Erythematosus (SLE) is an autoimmune condition that has been described in correlation with SARS-CoV-2 infection in adult patients. Our patient fulfills SLICC criteria for SLE and a temporal relationship exists between SARS-CoV-2 infection and the development of SLE antibodies. SARS-CoV2 has also been reported to directly cause nephritis, although with more tubular than glomerular involvement. A renal biopsy is required for accurate diagnosis.