Abstract: TH-PO0879
COVID-19-Associated Nephropathy (COVAN) in a Kidney Transplant Recipient
Session Information
- Glomerular Case Reports: Potpourri
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Sudheer, Namitha, Methodist Health System, Dallas, Texas, United States
- Hanna, Wael A., Methodist Health System, Dallas, Texas, United States
- Collazo-Maldonado, Roberto L., Methodist Health System, Dallas, Texas, United States
Introduction
Covid-19 infection in renal transplant recipients has been associated with high incidence of AKI via several mechanisms. Incidence of Covid-19 associated collapsing focal segmental glomerulosclerosis (COVAN) has been less than 5%. We present a case of renal transplant recipient who developed rapid onset collapsing FSGS associated with COVID-19 infection.
Case Description
67 yo Hispanic man with h/o ESRD 2/2 diabetic kidney disease on in center HD s/p deceased donor kidney transplant 5yrs ago who presented with AKI (rise in serum Cr to 15.8 mg/dl from baseline– 1.2mg/dl). He was diagnosed of Covid-19 infection 1 week prior to presentation. Urinalysis showed massive proteinuria and microscopic hematuria. Serum albumin was 2.9 g/dl. He was positive on RT-PCR for Covid 19 and negative on all rest of respiratory viral panel. Kidney biopsy showed Collapsing FSGS. APOL1 genotyping showed donor to be heterozygous for Wild-type G2 alleles and recipient with no variant risk alleles, no evidence of rejection. The patient was treated with Remdesivir, IV corticosteroids and intermittent HD. His dose of CNI was adjusted targeting a lower limit of therapeutic range and antimetabolite was held. Kidney function is improving after receiving HD for 6 weeks.
Discussion
Viral infections have been one of the causes of collapsing FSGS in kidney transplant recipients. Incidence of allograft loss has been reported in 4%-11% with Covid-19. COVAN is most seen in African descents who carry APOL1 risk variants. Trials have shown that recipients of kidneys from donors with 2 APOL 1 risk variants have shorter graft survival and are at higher risk of graft loss. But COVAN has also been described in association with Covid-19 infection in a patient who was heterozygous for wild-type and G1 alleles of APOL1. Covid-19 infection may act as a “second hit” in patients with APOL1 risk alleles. Immunosuppression should be based on severity of illness and weighed against the risks of allograft loss. A 50% reduction to complete cessation of the antimetabolite and targeting lower limit of therapeutic range for calcineurin inhibitors to complete discontinuation and increasing dose of corticosteroids to prevent rejection has been recommended depending on severity of the infection.It is important to consider COVAN in kidney transplant recipients with AKI and massive proteinuria with recent Covid-19.