ABSTRACT
As COVID-19 (coronavirus disease 2019) spreads across the world multiple therapeutic interventions have been tried to reduce morbidity and mortality. We describe a case of collapsing focal sclerosing glomerulosclerosis (FSGS) and acute oxalate nephropathy in a patient treated with high-dose intravenous vitamin C for severe COVID-19 infection. Collapsing FSGS has been described in patients with COVID-19 infection associated with APOL-1; however, this case had collapsing FSGS developing in low-risk heterozygous APOL-1 variant, and we postulate that the intensity of the COVID-19 cytokine storm overwhelmed the protective state of APOL-1 heterozygosity. This case illustrates the importance of assessing the risk and benefit of planned therapeutic interventions on a case-by-case basis especially when there are still so many unknowns in the management of COVID-19 infection. Strong consideration should be given for performing a renal biopsy in patients who develop multifactorial acute kidney injury.
Subject(s)
Ascorbic Acid/adverse effects , Betacoronavirus , Coronavirus Infections/drug therapy , Glomerulosclerosis, Focal Segmental/chemically induced , Hyperoxaluria/chemically induced , Kidney Glomerulus/pathology , Oxalates/metabolism , Pneumonia, Viral/drug therapy , Acute Disease , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Ascorbic Acid/administration & dosage , Biopsy , COVID-19 , Coronavirus Infections/epidemiology , Disease Progression , Glomerulosclerosis, Focal Segmental/diagnosis , Humans , Hyperoxaluria/diagnosis , Hyperoxaluria/metabolism , Injections, Intravenous , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Vitamins/administration & dosage , Vitamins/adverse effectsABSTRACT
Coronavirus disease 19 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been associated with acute kidney injury, presumably due to acute tubular injury. However, this does not explain proteinuria, sometimes severe, and hematuria often observed. We present 2 African American patients with glomerulopathy demonstrated by kidney biopsy in the setting of acute kidney injury and COVID-19 infection. Kidney biopsy specimens showed a collapsing variant of focal segmental glomerulosclerosis in addition to acute tubular injury. Both patients were homozygous for apolipoprotein L1 (APOL1). COVID-19 infection likely caused the interferon surge as a second hit causing podocyte injury leading to collapsing focal segmental glomerulosclerosis. APOL1 testing should be strongly considered in African American patients with nephrotic-range proteinuria. More data from future kidney biopsies will further elucidate the pathology of kidney injury and glomerular involvement from COVID-19 infections.