De Novo Relapsing Podocytopathies Following Novel COVID-19 Infection: A Case Series
- Glomerular Diseases: Podocyte Biology - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1403 Podocyte Biology
- Vadpey, Omid, University of California Irvine, Irvine, California, United States
- Siu, Man Kit Michael, University of California Irvine, Irvine, California, United States
- Abdelmalek, Antoinette, University of California Irvine, Irvine, California, United States
COVID-19 Infection can result in significant multi-system disease, including pneumonia and renal pathologies. Thirty published articles have shown wide yet limited variety of underlying pathologies including collapsing FSGS, minimal change disease, and TMA following infection and vaccination. Our case series reintroduces discussion for unique podocytopathies following COVID-19 infection and vaccination, with relapsing MCD proteinuria, resistant MCD, and TIPS variant FSGS.
Our first case is a 22 year old female, with no past medical history, who had an initial presentation of abdominal distension, extremity edema, nausea, and novel COVID-19 positivity, with a 24 urine protein of 5.3g, and secondary serologies negative. Her renal biopsy showed MCD phenotype. Her proteinuria initially responded to prednisone therapy, but relapsed secondary to a taper, requiring rituximab, with remission over 3 months.
For this second case, a 36 year old male with a history of mast cell activation syndrome, thin basement membrane nephropathy, anabolic steroid use, presented with lower extremity edema and proteinuria of microalbumin to creatinine ratio of 4.5g, with kidney biopsy demonstrating TIPS variant FSGS, following COVID-19 infection positivity. Patient with poor tolerance to tacrolimus and prednisone due to adverse drug reactions, pending evaluation for sparsentan and rituximab.
The third case is a 43 year old female with a history of APLS, presented with swelling, proteinturia, following COVID-19 infection, found to have a 24 hr urine protein of 10.7 grams. Patient initially responded to prednisone, however, had flare of proteinuria following taper, and COVID-19 vaccinations. Course unresponsive to cyclophosphamide treatment, with minimal responsiveness to rituximab, however given anticoagulation for APLS, repeat biopsy deferred.
This case series reinforces an association between COVID-19 infection, vaccination and podocytopathy. However, it also provides groundwork for exploration of resistant and relapsing nephrotic syndromes, and the utility in early biopsies for early treatment. This raises the question whether there are long term effects of COVID-19 on renal health, and if COVID-19 induced nephrotic syndrome deserves its own treatment guidelines over traditional therapies.