Nephrotic Syndrome Secondary to Podocytopathy in SARS-COV2 Infection

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is cha-racterized by pulmonary involvement. However, there are reports on patients also suffering from concomitant renal involvement, with clinical manifestations such as hematuria, proteinuria, ele-vated nitrogen levels and acute kidney injury. Objective: The present study reports two clinical cases of nephrotic syndrome associated with coronavirus disease (COVID-19). Clinical case presentation: Histological imaging by electron microscopy showed, in one case, evidence of minimal changes and fusion of podocytes pedicels, and in the other one, podocyto-pathy with pedicels loss (70 %) and focal sclerosis of capillary loops. Discussion: Proteinuria in COVID-19 can be secondary to glomerular and acute tubular lesions, with a multifactorial origin: Hemodynamic factors, cytokine storms, secondary infections, drug-induced nephrotoxicity and direct viral infection (proximal tubule cells and podocytes). The latter mechanisms could be explained by SARS-CoV2 renal tropism. Conclusion: The present report presents two cases of nephrotic syndrome secondary to po-docytopathy in patients suffering from acute COVID-19 infection. © 2023, Asociacion Colombiana de Nefrologia e Hipertension Arterial. All rights reserved.

AKI associated with COVID-19: Differences between previously healthy kidney individuals and CKD patients

Background: Renal injury associated to COVID-19 has an incidence of 3-9%, which ranged from urinary abnormalities up to acute kidney injury (AKI-COVID19), which is mainly observed in critical care patients. The main risk factors for AKI-COVID19 appearance are: oncologic disease, sepsis, heart failure. However, it has not described if there are differences between AKI-COVID19 in patients with previously healthy kidney (AKI-NRF) and those with chronic kidney disease (AKI-CKD), thus we decided to explore it in patients who were assisted during the first pandemic wave (2020) in Clinica de la Costa, Barranquilla, Colombia Methods: 572 patients with confirmed diagnosis of COVID-19 (PCR) were evaluated. Out of them 188 developed AKI and their epidemiological data, serum parameters, and functional status were recorded. Statistical analysis and comparison between AKI-NRF and AKI-CKD patients were performed Results: From 720 individuals evaluated at the emergency room for suspicion of COVID-19, 572 of them were admitted with confirmed SARS-CoV-2 infection. Most of them were male (59%), median age 55 years, with hypertension (36%), obesity (23%), diabetes (18%), heart disease (5%), and COPD (9%). Almost all patients were robust (97%). 188 COVID-19 patients developed AKI (33%), although 149 (26%) presented a previous normal renal function (AKI-NRF), while 39 (7%) had CKD (AKI-CKD). Most of CKD patients (91%) developed AKI. There was a predominance of male gender, old age (≥ 60 years), frailty status (CFS ≥ 4), diabetes mellitus, obesity, COPD in AKI group (AKI-NRF and AKI-CKD subgroups) respect to NO AKI group (n: 380). The prevalence of hypertension and cardiac disease was significantly higher in AKI-CKD respect to AKI-NRF, and even higher respect to NO AKI. However, there was a tendency of higher mortality rate in AKI-NRF (69%) compared to AKI-CKD (56%). Even though, this trend did not reach statistical significance (p=0.09), mortality rate in AKI compared to NO AKI (16%) (p=<0.0001) did. D-dimer was slightly higher in AKI-NRF compared to AKI-CKD (p=0.06) Conclusions: There was a trend to higher mortality rate and D-dimer levels in AKINRF individual compared to AKI-CKD patients.