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Abstract: TH-PO738

COVID-19 Unmasking Concurrent IgA Nephropathy and Minimal Change Disease

Session Information

Category: Glomerular Diseases

  • 1403 Podocyte Biology

Authors

  • Roan, Rachel J., Temecula Valley Hospital, Temecula, California, United States
  • Lam, Jason Navarro, Temecula Valley Hospital, Temecula, California, United States
  • Chang, David, Temecula Valley Hospital, Temecula, California, United States
Introduction

The existence of concurrences of Minimal Change Disease (MCD) and IgA nephropathy (IgAN) is exceedingly rare. This is an unusual case of COVID-19 unmasking a dual glomerulopathy of MCD and IgAN.

Case Description

54-year-old Asian female presented with flu-like symptoms, worsening anasarca, and bubbly urine. She was hemodynamically stable on room air. Exam was pertinent for lung crackles, edematous eyelids, and +2 lower extremities edema. Labs showed BUN 50mg/dL, creatinine (Cr) 2.9mg/dL, and albumin 0.8mg/dL. Baseline Cr was 0.61mg/dL. Urine analysis showed >300mg/dL proteins with large blood and dysmorphic RBC. A spot urine protein 5065.9 mg/dL and Cr 389 gm/dL. COVID-19 was positive. Glomerulonephritis panel was negative. Kidney biopsy under immunofluorescence microscopy showed diffuse segmental granular mesangial staining +2 IgA. Electron Microscopy showed extensive effacement of podocyte foot processes (> 90%) with dense deposits in the mesangium. Concurrence of IgAN and MCD was diagnosed and she was started on prednisone and lisinopril.

Discussion

This highlights the rarity of the co-existence of two glomerular diseases with COVID-19. We postulate the likelihood that our patient had long-standing IgAN given the disease's indolent course, followed by the development of MCD from COVID-19 infections. There have been similar cases showing the concurrence of the two diseases, but there has been no report with COVID-19 infection. After treating the patient with steroids for total of 3 months, our patient was able to successfully remain in remission.

Foot process effacement

IgA immune deposits