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Kidney Week

Abstract: TH-PO1099

COVID-19-Associated C-ANCA Vasculitis

Session Information

  • COVID-19 - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Vaitla, Pradeep, The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Atari, Mohammad, The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Kapoor, Sanjana, The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Simhadri, Prathap, Advent Health, Daytona Beach, Florida, United States
Introduction

Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis is a group of systemic vasculitis that causes inflammation and destruction of the small and medium-sized blood vessels and can cause acute renal failure. SARS-CoV-2 (COVID-19) has been shown to increase the risk for autoimmune diseases. We present a case of C-ANCA vasculitis a few weeks after COVID-19 infection which was successfully treated with steroids and Rituximab.

Case Description

87-year-old female with hypertension presented with generalized weakness, malaise, and myalgias. She had COVID-19 infection with bronchitis symptoms a few weeks before the presentation. She has no history of kidney disease; labs showed creatinine of 2.99 mg/dl, BUN of 36 mg/dl with eGFR of 14. Urine dipstick showed 3+ proteinuria and 3+ hematuria.

Labs showed serum Anti-proteinase-3 antibody titers of 1:946, C-ANCA titers of 1:1280, and myeloperoxidase, P-ANCA were negative. Renal biopsy showed necrotizing and crescentic glomerulonephritis. Immunofluorescence: granular mesangial and capillary loop staining with 3+ staining for IgG, IgM, C3, kappa, and lambda.

Infection-related crescentic vasculitis was considered and ruled out with negative blood and urine cultures. She was given pulse dose steroids and four weekly doses of Rituximab. Prednisone was tapered to 10 mg daily over 8 weeks. She had significant improvement with her generalized weakness, anemia, and myalgias. Even though her eGFR recovery (17) was marginal, proteinuria and hematuria resolved completely and ANCA titers improved which indicates improving vasculitis activity.

Discussion

A few cases of COVID-19-associated ANCA vasculitis have been reported but data regarding management is scarce. Our case highlights the safety and efficacy of prompt Rituximab and steroid therapy in patients with COVID-associated ANCA vasculitis.