Collapsing FSGS in a Patient with Post-COVID-19 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)
- Khan, Fazal, St. Francis Emory Healthcare, Columbus, Georgia, United States
- Tzorin, Pablo David, St. Francis Emory Healthcare, Columbus, Georgia, United States
- Mirkin, Evgeni, St. Francis Emory Healthcare, Columbus, Georgia, United States
- Jarrell, Harold George, St. Francis Emory Healthcare, Columbus, Georgia, United States
- Martinez, Jonathan, St. Francis Emory Healthcare, Columbus, Georgia, United States
Focal segmental glomerulosclerosis accounted for about one sixth of cases of nephrotic syndrome prior to the COVID pandemic. This disease is focal, involving some glomeruli, and segmental, involving part of the glomerulus. Patients may present with either nephrotic or nephritic syndrome.
This abstract describes a 40-year-old Caucasian female who presented post-COVID pandemic with nephrotic range proteinuria after being asymptomatic for the past 14-years. Renal biopsy revealed collapsing glomerulopathy. This case demonstrates CKD patient post-COVID that presented with nephrotic range proteinuria, however non-uremic and not on dialysis despite worsening laboratory findings.
Kidney failure in the form of COVID associated nephropathy (COVAN) is associated with increased morbidity and mortality. Few large cohort studies of kidney biopsies from patients with COVID-19 have been completed-to-date.
A 40-year-old Caucasian female with a history of Hypertension, Vitamin-D deficiency, CKD stage 5 and nephrotic range proteinuria with a baseline creatinine around 2 mg/dL for the last 14-years presented asymptomatically with a serum creatinine of 4.5-4.9 mg/dL after approximately 1-year hiatus due to the COVID pandemic. Renal biopsy was performed and revealed collapsing glomerulopathy with focal segmental glomerulosclerosis. A biopsy approximately 15 years ago showed unremarkable pathological findings. She started treatment with repository corticotropin injection with subsequent development of anasarca and interval elevation in creatinine to 6 mg/dL. Treatment was stopped. She remained non-oliguric with close monitoring and supportive management of her co-morbidities.
The progress of our patient's sub-nephrotic range proteinuria and CKD before and after COVAN with transition into nephrotic range proteinuria and without ATN findings shows the unique presentation of individuals with COVID associated FSGS. There is still yet to be understood regarding the mechanism in which patient present with worsening prognosis depsite remaining Non-oliguric and non-uremic.
Few studies have shown an endpoint in the understanding and management of COVID FSGS and despite different treatment therapies available, COVID-FSGS remains yet to be fully understood. Patients infected with COVID-19 may present with mimicking features of commonly presenting renal pathology.