New Onset of Membranous Nephropathy and Renal Vein Thrombosis After SARS-CoV-2 Infection
- 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)
- Qadir, Areebah, Bakhtawar Amin Medical and Dental College, Multan, Punjab, Pakistan
- Hameed, Aamna Faisal, Shifa College of Medicine, Islamabad, Pakistan
- Khan, Mohammad Raza, Bakhtawar Amin Medical and Dental College, Multan, Punjab, Pakistan
- Khakwani, Aemen Shams, Suburban Community Hospital, Norristown, Pennsylvania, United States
- Mustafa, Nabiha, Bakhtawar Amin Medical and Dental College, Multan, Punjab, Pakistan
- Munir, Sadaf, CMH Multan Institute of Medical Sciences, Multan, Punjab, Pakistan
- Khan, Usman A., University of Oklahoma and VA Medical Centre, Oklahoma City, Oklahoma, United States
COVID-19 was identified as a cause of a cluster of pneumonia cases in the province of Wuhan in China in 2019 and soon was declared a pandemic by WHO in February 2020. Though COVID-19 is mainly a pulmonary disease, there have also been reports of extrapulmonary manifestations of the disease affecting the renal system, among other systems. We present a unique case of a patient diagnosed with membranous nephropathy post-COVID-19 infection.
A 37-year-old man presented to the Emergency department with primary complaints of hematuria, fever, and right lower quadrant abdominal pain. Recent past medical history revealed mild Covid-19 infection with resolution in 2 weeks. Laboratory analysis showed creatinine at 1.8mg/dL, protein to creatinine ratio of 9.5g/g, and albuminuria of 12g/L. Doppler of both kidneys showed right renal vein thrombosis. Biopsy on day 4 showed thickening of the basement membrane with PLA2R staining positive. The patient was started on ACE inhibitors and rituximab for 14 days. After following the prescribed regimen, the patient showed complete resolution of proteinuria, with normal creatinine function.
Membranous nephropathy can be primary PLA2R+ or secondary, and COVID-19 infection and immunization have recently been linked to its increased incidence. Podocytes, neutrophils, airway epithelial cells, and macrophages all express PLA2R-Antigen, and upon getting triggered by a foreign antigen such as COVID-19 these cells release extracellular vesicles containing PLA2R or cause the longitudinal release of PLA2R by engendering extracellular traps, subsequently exciting B lymphocytes to produce PLA2R-Antibody. Additionally, the oxidative environment induced by inflammatory cytokines may result in longstanding expression of PLA2R pathogenic epitopes and increase their ability to bind to circulating antibodies. We believe a recent COVID-19 infection, triggered this cascade in our young 37-year-old patient and resulted in nephrotic syndrome, albuminuria, membranous nephropathy, and renal vein thrombosis.