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1.
Ultrastruct Pathol ; 47(1): 22-29, 2023 Jan 02.
Article in English | MEDLINE | ID: covidwho-2246155

ABSTRACT

Infection-related glomerulonephritis is well recognized in patients with ongoing infections. It can be missed, however, if the infection is unusual or undetected. We present three cases where the renal biopsy findings prompted the identification or treatment of systemic infections.Case 1: A 84-year-old male presented with acute kidney injury (AKI) and IgA vasculitis on skin biopsy. A renal biopsy showed active glomerulonephritis with abundant neutrophils and predominantly mesangial immune complex deposits containing IgA. The findings prompted an infectious workup which was positive for COVID-19, suggesting exacerbation of IgA nephropathy by recent COVID-19 infection. Case 2: A 31-year-old female status post kidney transplant for granulomatosis with polyangiitis (GPA) had recent pregnancy with preterm delivery, disseminated herpes simplex virus (HSV) infection with HSV hepatitis, E. coli on urine culture, and AKI. A renal biopsy showed proliferative glomerulonephritis with subendothelial and mesangial immune complex deposits containing IgG and C3. The findings were most consistent with infection-related immune complex glomerulonephritis, most likely HSV-related. Case 3: A 78-year-old female presented with AKI, proteinuria, hematuria, and positive p-ANCA. Clinically, ANCA vasculitis was suspected, and renal biopsy did show focal, segmental, necrotizing glomerulonephritis. However, immunofluorescence and electron microscopy showed IgM-rich deposits in the mesangium. The unusual presentation prompted an infectious workup including a Bartonella antibody panel which showed very high titers, suggesting Bartonella endocarditis.Infection-related glomerulonephritis has a wide variety of presentations histologically and clinically. The three cases we present here emphasize the importance of recognizing these entities to help guide treatment and improve patient care.


Subject(s)
Acute Kidney Injury , COVID-19 , Glomerulonephritis, IGA , Glomerulonephritis , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Acute Kidney Injury/etiology , Antigen-Antibody Complex , Biopsy , COVID-19/complications , Escherichia coli , Glomerulonephritis/pathology , Glomerulonephritis, IGA/pathology
2.
BMJ Case Rep ; 16(1)2023 Jan 05.
Article in English | MEDLINE | ID: covidwho-2193662

ABSTRACT

COVID-19 primarily presents with respiratory involvement. Extrapulmonary manifestations as the sole manifestation also occur although rare. The kidney, being one of the organs with the greatest number of ACE receptors, is usually reported as part of multiorgan involvement. We report an early adolescent boy who presented with nephrotic-nephritic syndrome with severe kidney dysfunction from COVID-19 infection. He had low C3 and undetected antineutrophil cytoplasmic antibodies, antinuclear antibody and antistreptolysin O. Kidney biopsy revealed findings consistent with diffuse proliferative glomerulonephritis with a focal glomerular crescent formation and thin basement nephropathy. Due to the rapidly progressive deterioration of kidney function, he was given pulse methylprednisolone therapy followed by oral prednisone. Complete recovery was documented 12 weeks after the onset of post-infectious glomerulonephritis. The possible pathogenesis of glomerulonephritis in a patient with COVID-19, its differential diagnosis and treatment are discussed.


Subject(s)
COVID-19 , Glomerulonephritis , Kidney Diseases , Renal Insufficiency , Male , Adolescent , Humans , COVID-19/complications , COVID-19/pathology , Glomerulonephritis/complications , Glomerulonephritis/diagnosis , Glomerulonephritis/drug therapy , Kidney/pathology , Kidney Diseases/complications , Renal Insufficiency/complications
3.
Ultrastruct Pathol ; 47(1): 22-29, 2023 Jan 02.
Article in English | MEDLINE | ID: covidwho-2186888

ABSTRACT

Infection-related glomerulonephritis is well recognized in patients with ongoing infections. It can be missed, however, if the infection is unusual or undetected. We present three cases where the renal biopsy findings prompted the identification or treatment of systemic infections.Case 1: A 84-year-old male presented with acute kidney injury (AKI) and IgA vasculitis on skin biopsy. A renal biopsy showed active glomerulonephritis with abundant neutrophils and predominantly mesangial immune complex deposits containing IgA. The findings prompted an infectious workup which was positive for COVID-19, suggesting exacerbation of IgA nephropathy by recent COVID-19 infection. Case 2: A 31-year-old female status post kidney transplant for granulomatosis with polyangiitis (GPA) had recent pregnancy with preterm delivery, disseminated herpes simplex virus (HSV) infection with HSV hepatitis, E. coli on urine culture, and AKI. A renal biopsy showed proliferative glomerulonephritis with subendothelial and mesangial immune complex deposits containing IgG and C3. The findings were most consistent with infection-related immune complex glomerulonephritis, most likely HSV-related. Case 3: A 78-year-old female presented with AKI, proteinuria, hematuria, and positive p-ANCA. Clinically, ANCA vasculitis was suspected, and renal biopsy did show focal, segmental, necrotizing glomerulonephritis. However, immunofluorescence and electron microscopy showed IgM-rich deposits in the mesangium. The unusual presentation prompted an infectious workup including a Bartonella antibody panel which showed very high titers, suggesting Bartonella endocarditis.Infection-related glomerulonephritis has a wide variety of presentations histologically and clinically. The three cases we present here emphasize the importance of recognizing these entities to help guide treatment and improve patient care.


Subject(s)
Acute Kidney Injury , COVID-19 , Glomerulonephritis, IGA , Glomerulonephritis , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Acute Kidney Injury/etiology , Antigen-Antibody Complex , Biopsy , COVID-19/complications , Escherichia coli , Glomerulonephritis/pathology , Glomerulonephritis, IGA/pathology
5.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2247921.v1

ABSTRACT

Introduction This case report represents, to our knowledge, the first suspected case of Light Chain Deposition Disease (LCDD) relapse associated with mRNA COVID-19 vaccination. It must be made clear that timing is the only link between the vaccination and the relapse of LCDD, and since millions of individuals received these vaccines, an event like this may be due to chance. At the same time, this case report may be an entry point into further explorations of the pathogenesis of LCDD, given the mechanism of action of the vaccine and the pathophysiology of the disease, as it is currently understood. Case presentation The 75-year-old female patient of Greek ethnicity was admitted into our clinic for the investigation of worsening renal function that was detected on routine lab examinations two weeks after she received the second dose of the moderna COVID vaccine (mRNA-1273). Rapidly progressive glomerulonephritis and anemia were the most notable findings upon admission. She had a history of Light Chain Deposition Disease (LCDD) which had remained stable under management for four years. Serum protein electrophoresis was performed and showed monoclonal kappa zones, while bone marrow biopsy revealed 5% plasma cell infiltration. All the above, along with other investigations, established the diagnosis of LCDD recurrence. She was started on chemotherapy, which improved her immunological profile but not her renal function. The patient has remained on hemodialysis since. Conclusions The association between mRNA vaccinations and LCDD relapse may be ground for investigations into the pathophysiology of MGRS, given the patient’s previous long-term remission. In this context, we want to stress once again the importance of following standardized routine mandates on COVID vaccination, especially in immunocompromised patients. This case report is not intended to directly inform changes in clinical practice.


Subject(s)
COVID-19 , Glomerulonephritis , Paraproteinemias , Anemia , Immunoproliferative Small Intestinal Disease , Photophobia
6.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2243420.v1

ABSTRACT

Recently, there have been reports of new cases of acute kidney injury (AKI) after coronavirus disease 2019 (COVID-19) vaccination. Podocytic damage, IgA nephropathy, vasculitis, tubulointerstitial damage, and thrombotic microangiopathy have been reported as the causes. However, there are no reports of acute tubular injury (ATI) as the sole cause of AKI. In this case, a 54-year-old man with type 2 diabetes visited a local physician. He was highly obese with a body mass index of 36 kg/m2. He was treated with metformin and insulin. Diabetic retinopathy, urinary protein, and occult blood were absent. He had received four COVID-19 vaccines; three were from Pfizer and one from Moderna. He was referred to our hospital 5 days after receiving the fourth dose of the Pfizer-BioNTech COVID-19 vaccine. He had stage 3 AKI. Urinary findings revealed the presence of new proteinuria and glomerular occult blood. Steroids were introduced on the day of admission for rapidly progressive glomerulonephritis. A renal biopsy was performed on the second day, with results obtained on the fifth day revealing no findings other than ATI. The patient was therefore deemed unamenable to steroids. After steroid discontinuation, renal function recovered spontaneously, and urinalysis abnormalities disappeared. In this case, ATI was the sole pathogenesis of COVID-19 vaccine-induced AKI, and treatment with immunosuppressive drugs was not necessary.


Subject(s)
COVID-19 , Acute Disease , Glomerulonephritis , Acute Kidney Injury , Nephritis, Interstitial , Kidney Diseases , Obesity , Thrombotic Microangiopathies , Diabetes Mellitus, Type 2 , Diabetic Retinopathy , Proteinuria , Cardiovascular Abnormalities , Vasculitis
7.
J Autoimmun ; 132: 102899, 2022 10.
Article in English | MEDLINE | ID: covidwho-2028166

ABSTRACT

Coronavirus disease 2019 (COVID-19) and vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been associated with autoimmune phenomena. However, the interplay between COVID-19 or vaccination against SARS-CoV-2 and Berger glomerulonephritis or Henoch-Schönlein vasculitis, two diseases mediated by immunoglobulin A, has never been comprehensively investigated. Therefore, we carried out a systematic review of the literature on this topic. Following databases were used: Google Scholar, Excerpta Medica and the United States National Library of Medicine. Eighty-seven patients with immunoglobulin A-mediated diseases associated with SARS-CoV-2 infection or vaccination against coronavirus were sorted out (53% males, 47% females; 34 17-51 years of age, median and interquartile range): 47 cases of Berger glomerulonephritis and 40 of Henoch-Schönlein vasculitis. Approximately 50% (N = 24) of Berger glomerulonephritis and 10% (N = 4) of Henoch-Schönlein vasculitis patients presented with a pre-existing history of immunoglobulin A-mediated disease. Almost all cases of Berger glomerulonephritis were vaccine-associated (N = 44; 94%), while most cases of Henoch-Schönlein vasculitis were infection-associated (N = 23; 57%). Among vaccine-associated immunoglobulin A diseases, about 90% were associated to mRNA-based vaccines. Our analysis supports the hypothesis that COVID-19 and vaccination against SARS-CoV-2 may trigger or exacerbate an immunoglobulin A-mediated diseases.


Subject(s)
COVID-19 , Glomerulonephritis , IgA Vasculitis , Humans , Male , Female , Immunoglobulin A , COVID-19/prevention & control , SARS-CoV-2 , Vaccination
8.
Kidney Int ; 102(6): 1409-1419, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2015782

ABSTRACT

Numerous cases of glomerulonephritis manifesting shortly after SARS-CoV-2 vaccination have been reported, but causality remains unproven. Here, we studied the association between mRNA-based SARS-CoV-2 vaccination and new-onset glomerulonephritis using a nationwide retrospective cohort and a case-cohort design. Data from all Swiss pathology institutes processing native kidney biopsies served to calculate incidence of IgA nephropathy, pauci-immune necrotizing glomerulonephritis, minimal change disease, and membranous nephropathy in the adult Swiss population. The observed incidence during the vaccination campaign (January to August 2021) was not different from the expected incidence calculated using a Bayesian model based on the years 2015 to 2019 (incidence rate ratio 0.86, 95% credible interval 0.73-1.02) and did not cross the upper boundary of the 95% credible interval for any month. Among 111 patients 18 years and older with newly diagnosed glomerulonephritis between January and August 2021, 38.7% had received at least one vaccine dose before biopsy, compared to 39.5% of the general Swiss population matched for age and calendar-time. The estimated risk ratio for the development of new-onset biopsy-proven glomerulonephritis was not significant at 0.97 (95% confidence interval 0.66-1.42) in vaccinated vs. unvaccinated individuals. Patients with glomerulonephritis manifesting within four weeks after vaccination did not differ clinically from those manifesting temporally unrelated to vaccination. Thus, vaccination against SARS-CoV-2 was not associated with new-onset glomerulonephritis in these two complementary studies with most temporal associations between SARS-CoV-2 vaccination and glomerulonephritis likely coincidental.


Subject(s)
COVID-19 , Glomerulonephritis , Adult , Humans , Incidence , Retrospective Studies , Bayes Theorem , COVID-19 Vaccines/adverse effects , SARS-CoV-2 , COVID-19/epidemiology , COVID-19/prevention & control , Glomerulonephritis/epidemiology , Glomerulonephritis/etiology , Vaccination/adverse effects , RNA, Messenger
9.
Clin Nephrol ; 98(4): 205-208, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1964358

ABSTRACT

Fibrillary glomerulonephritis (FGN) is a rare glomerular disease manifesting with proteinuria, renal impairment, hematuria, hypertension, and in a very small proportion can be associated with rapidly progressive glomerulonephritis and, rarely, crescent formation. The main modality for diagnosis is kidney biopsy, which ultrastructurally demonstrates randomly arranged non-branching mesangial and glomerular basement membrane (GBM) fibrils and positive staining for the biomarker DNAJB9. The pathogenesis is largely unknown. It was previously hypothesized to represent an immune-complex-type glomerulonephritis, as most cases show IgG4 restriction. We present the first case of crescentic FGN after mRNA Pfizer vaccine for COVID-19. A strong temporal association between vaccination, elevated creatinine, and diffuse crescentic fibrillary process was found. Immunological, neoplastic, and infectious causes were ruled out. We hypothesized that the vaccine stimulated an immune response that triggered crescentic FGN, however, further investigations will be needed to elucidate the direct role of COVID-19 vaccination in crescentic glomerular disease.


Subject(s)
Acute Kidney Injury , COVID-19 , Glomerulonephritis, Membranoproliferative , Glomerulonephritis , Acute Kidney Injury/etiology , Acute Kidney Injury/pathology , Biomarkers , Biopsy , COVID-19/complications , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Creatinine , Glomerular Basement Membrane/pathology , Glomerulonephritis/diagnosis , Glomerulonephritis, Membranoproliferative/pathology , HSP40 Heat-Shock Proteins , Humans , Immunoglobulin G , Membrane Proteins , Molecular Chaperones , RNA, Messenger
10.
J Korean Med Sci ; 37(26): e204, 2022 Jul 04.
Article in English | MEDLINE | ID: covidwho-1924066

ABSTRACT

Despite that clinical trials have been examining the safety profile of coronavirus disease 2019 (COVID-19) vaccines, there are concerns about long-term side effects as the number of vaccinations increases. Herein, we report a case of new-onset renal-limited anti-myeloperoxidase (MPO) antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis after booster vaccination with the mRNA 1273 (Moderna) vaccine. A 72-year-old woman with no specific past history, and who had a normal renal function, developed ANCA-associated vasculitis following heterologous booster with mRNA1273 (Moderna) vaccine. After a kidney biopsy, she was diagnosed with ANCA-associated pauci-immune crescentic glomerulonephritis. Her renal function and constitutional symptoms have been improved with treatment with plasmapheresis, intravenous cyclophosphamide and steroid pulse therapy (intravenous 500 mg of methylprednisolone sodium succinate for 3 days) followed by a reduced steroid regimen.


Subject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis , COVID-19 , Glomerulonephritis , Aged , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/etiology , Antibodies, Antineutrophil Cytoplasmic , Female , Glomerulonephritis/pathology , Humans , Vaccination/adverse effects
11.
J Korean Med Sci ; 37(19): e154, 2022 May 16.
Article in English | MEDLINE | ID: covidwho-1847143

ABSTRACT

Coronavirus disease 2019 (COVID-19) is one of the most widespread viral infections in human history. As a breakthrough against infection, vaccines have been developed to achieve herd immunity. Here, we report the first case of microscopic polyangiitis (MPA) following BNT162b2 vaccination in Korea. A 42-year-old man presented to the emergency room with general weakness, dyspnea, and edema after the second BNT162b2 vaccination. He had no medical history other than being treated for tuberculosis last year. Although his renal function was normal at last year, acute kidney injury was confirmed at the time of admission to the emergency room. His serum creatinine was 3.05 mg/dL. Routine urinalysis revealed proteinuria (3+) and hematuria. When additional tests were performed for suspected glomerulonephritis, the elevation of myeloperoxidase (MPO) antibody (38.6 IU/mL) was confirmed. Renal biopsy confirmed pauci-immune anti-neutrophil cytoplasmic antibody (ANCA)-related glomerulonephritis and MPA was diagnosed finally. As an induction therapy, a combination of glucocorticoid and rituximab was administered, and plasmapheresis was performed twice. He was discharged after the induction therapy and admitted to the outpatient clinic 34 days after induction therapy. During outpatient examination, his renal function had improved with serum creatinine 1.51 mg/dL. We suggest that MPA needs to be considered if patients have acute kidney injury, proteinuria, and hematuria after vaccination.


Subject(s)
Acute Kidney Injury , COVID-19 , Glomerulonephritis , Microscopic Polyangiitis , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Adult , Antibodies, Antineutrophil Cytoplasmic , BNT162 Vaccine , COVID-19 Vaccines/adverse effects , Creatinine , Female , Glomerulonephritis/pathology , Hematuria/etiology , Humans , Male , Microscopic Polyangiitis/diagnosis , Microscopic Polyangiitis/drug therapy , Microscopic Polyangiitis/etiology , Proteinuria/etiology , RNA, Messenger , Vaccination
12.
Saudi Med J ; 43(5): 522-525, 2022 May.
Article in English | MEDLINE | ID: covidwho-1836052

ABSTRACT

COVID vaccinations have been an important step in controlling the COVID-19 pandemic. Despite the fact they were generally safe and effective, a few case reports of renal disorders have been published following COVID vaccines. We report a 29-year-old man with history of Chronic Kidney Disease who presented to our center with flank pain after receiving AstraZeneca COVID vaccine. He also had history of raw milk ingestion. His initial investigations showed high creatinine with high level of proteinuria. A renal biopsy was consistent with immune complex-mediated glomerulonephritis on top of renal fibrosis. His brucella serology also showed high titer. He was started on treatment for Brucellosis and planned for follow-up afterwards for further therapy. To the best of our knowledge, this is the first reported case of concomitant Brucellosis and post COVID vaccine glomerulonephritis.


Subject(s)
Brucellosis , COVID-19 , Glomerulonephritis , Vaccines , Adult , Antigen-Antibody Complex , Brucellosis/complications , Brucellosis/drug therapy , COVID-19/complications , COVID-19 Vaccines/adverse effects , Female , Glomerulonephritis/etiology , Glomerulonephritis/pathology , Humans , Male , Pandemics , Vaccination
13.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.05.18.22275112

ABSTRACT

Numerous cases of glomerulonephritis manifesting shortly after SARS-CoV-2 vaccination have been reported, but causality remains unproven. We studied the association between mRNA-based SARS-CoV-2 vaccination and new-onset glomerulonephritis using a nationwide retrospective cohort and case-cohort design. Data from all Swiss pathology institutes processing native kidney biopsies served to calculate incidence of IgA nephropathy, pauci-immune necrotizing glomerulonephritis, minimal change disease and membranous nephropathy. The observed incidence during the vaccination campaign (Jan to Aug 2021) was not different from the expected incidence based on the years 2015 to 2019 (incidence rate ratio 0.86, 95%-credible interval 0.73-1.02) and did not cross the upper boundary of the 95% credible interval for any month. Among 111 patients aged >18 years with newly diagnosed glomerulonephritis between January and August 2021, 38.7% had received at least one vaccine dose before biopsy, compared to 39.5% of the general Swiss population matched for age and calendar-time. The estimated risk ratio for the development of new-onset biopsy-proven glomerulonephritis was 0.97 (95% CI 0.66-1.42, P=0.95) in vaccinated vs. unvaccinated individuals. Patients with glomerulonephritis manifesting within 4 weeks after vaccine did not differ clinically from the rest of the cohort. Results were consistent across all types of glomerulonephritis with the possible exception of minimal change disease. In conclusion, vaccination against SARS-CoV-2 was not associated with new-onset glomerulonephritis in these two complementary studies. Most temporal associations between SARS-CoV-2 vaccination and glomerulonephritis are likely coincidental.


Subject(s)
Kidney Diseases , Glomerulonephritis , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
14.
Iran J Kidney Dis ; 16(2): 147-151, 2022 03.
Article in English | MEDLINE | ID: covidwho-1823867

ABSTRACT

Acute kidney injury (AKI) , proteinuria in the nephrotic or subnephrotic range and hematuria might be seen in patients with coronavirus disease 2019 (COVID-19) infection. In this case study we present a 59 years old manwho was diagnosed with immune-complex glomerulonephritis after development of rapidly progressive kidney failure accompanied by pulmonary hemorrhage, 2 months after COVID-19 infection. The patient was hospitalised with the diagnosis of acute kidney injury and nephrotic syndrome. Hemodialysis was performed due to uremic symptoms. Cyclophosphamide, methylprednisolone and plasmapheresis were started. Pathologic examination of kidney biopsy revealed features compatible with immune complex-related acute glomerulonephritis. Cyclophosphamide and plasmapheresis were discontinued , and treatment with 1 mg/kg/day methylprednisolone was continued. Immune-complex glomerulonephritis can be seen following COVID-19 infection. It is important to diagnose this disease entity as soon as possible . Steroidtherapy and other supportive modalities might be sufficient in the treatment.  DOI: 10.52547/ijkd.6527.


Subject(s)
Acute Kidney Injury , COVID-19 , Glomerulonephritis , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Cyclophosphamide , Female , Glomerulonephritis/diagnosis , Glomerulonephritis/drug therapy , Humans , Male , Methylprednisolone/therapeutic use , Middle Aged
15.
Clin Nephrol ; 97(5): 289-297, 2022 May.
Article in English | MEDLINE | ID: covidwho-1687331

ABSTRACT

Billions of COVID-19 vaccine doses have been administered to combat the ongoing global pandemic caused by severe acute respiratory syndrome coronavirus-2. While these vaccines are considered safe, with most adverse events being mild to moderate and transient, uncommon systemic side effects of the vaccines, including de novo or re-activation of various glomerular diseases have recently been observed. We report 6 patients who developed glomerular or acute tubulointerstitial disease shortly after receiving COVID-19 vaccinations. Five of these patients received mRNA vaccines (3 Moderna, 2 Pfizer-BioNTech) and 1 received adenovirus-26 vector vaccine (Johnson and Johnson/Janssen). Four of our patients developed de novo glomerulonephritis or acute tubulointerstitial nephritis (ATIN), while the other 2 had re-activation of prior glomerulonephritis. Two patients presented with acute kidney injury (AKI) characterized by severe ATIN. While both of them also had evidence of immune complex glomerular disease, ATIN was the dominant feature on the biopsies. Two other patients presented with high-grade proteinuria and AKI. Like the aforementioned patients, these patients had evidence of immune complex glomerular disease, but acute onset nephrotic syndrome was the leading clinical feature. Another patient presented with de novo myeloperoxidase-anti-neutrophil-cytoplasmic-antibody-associated pauci-immune crescentic glomerulonephritis. Yet another patient had re-activation of immunoglobulin-A glomerulonephritis that had been quiescent for several years prior to the vaccination. It is difficult to ascertain any causal relationship between COVID-19 vaccination and onset/recurrence of kidney diseases. However, vigilance about occurrence of such complications is imperative. Importantly, all our cases responded well to the immunosuppressive treatment.


Subject(s)
Acute Kidney Injury , COVID-19 , Glomerulonephritis , Acute Kidney Injury/etiology , Antigen-Antibody Complex , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Glomerulonephritis/pathology , Humans , Male , Nephritis, Interstitial , Vaccination
16.
authorea preprints; 2021.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.163578863.32575474.v1

ABSTRACT

Antineutrophil cytoplasmic autoantibodies associated vasculitis(AAV) is characterized by antibodies against antigens in cytoplasmic granules of neutrophils and predominantly affects small vessels. AAV after COVID-19 mRNA vaccination has been reported. We report rare case of AAV in a patient who presented with rapidly progressive glomerulonephritis(RPGN) after Johnson & Johnson vaccine administration.


Subject(s)
COVID-19 , Glomerulonephritis , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
17.
biorxiv; 2021.
Preprint in English | bioRxiv | ID: ppzbmed-10.1101.2021.09.08.459502

ABSTRACT

Collapsing glomerulopathy is a histologically distinct variant of focal and segmental glomerulosclerosis that presents with heavy proteinuria and portends a poor prognosis. Collapsing glomerulopathy can be triggered by viral infections such as HIV and SARS-CoV-2. Transcriptional profiling of collapsing glomerulopathy lesions is difficult since only a few glomeruli may exhibit this histology within a kidney biopsy and the mechanisms driving this heterogeneity are unknown. Therefore, we used recently developed digital spatial profiling (DSP) technology which permits quantification of mRNA at the level of individual glomeruli. Using DSP, we profiled 1,852 transcripts in glomeruli from HIV and SARS-CoV-2 infected patients with biopsy confirmed collapsing glomerulopathy. The increased resolution of DSP uncovered heterogeneity in glomerular transcriptional profiles that were missed in early laser capture microdissection studies of pooled glomeruli. Focused validation using immunohistochemistry and RNA in situ hybridization showed good concordance with DSP results. Therefore, DSP represents a powerful method to dissect transcriptional programs of pathologically discernible kidney lesions.


Subject(s)
HIV Infections , Glomerulonephritis , Kidney Diseases , Severe Acute Respiratory Syndrome , Proteinuria
18.
authorea preprints; 2021.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.162055806.69831997.v1

ABSTRACT

Background: Perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA), a subset of ANCA, are associated with a multisystem vasculitis affecting small blood vessels in the body. A handful of adult patients who developed vasculitis post-COVID-19 infection have been reported. Although COVID-19 infection has been shown to drive an exaggerated immune response in the pediatric population, such as MIS-C (multisystem inflammatory syndrome in children), only one case of vasculitis following COVID-19 infection has been reported previously in children. Case presentation: Seventeen-year-old male with a past medical history of COVID-19 pneumonia two months prior presented with acute kidney injury/failure and diffuse alveolar hemorrhage (DAH). Rheumatologic workup revealed P-ANCA and Myeloperoxidase (MPO) positivity. Kidney biopsy showed necrotizing glomerulonephritis with limited immune complex deposition. Subsequently, he was treated with pulse steroids, plasmapheresis, and ultimately started on cyclophosphamide. Conclusions: To our knowledge, this report presents the second reported pediatric case of P-ANCA / MPO vasculitis following COVID-19 infection.


Subject(s)
COVID-19 , Adenocarcinoma, Bronchiolo-Alveolar , Glomerulonephritis , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis , Acute Kidney Injury , Cryopyrin-Associated Periodic Syndromes , Vasculitis
19.
biorxiv; 2021.
Preprint in English | bioRxiv | ID: ppzbmed-10.1101.2021.01.29.428186

ABSTRACT

Proteinuria, the spillage of serum proteins into the urine, is a feature of glomerulonephritides, podocyte disorders and diabetic nephropathy. However, the response of tubular epithelial cells to serum protein exposure has not been systematically characterized. Using transcriptomic profiling we studied serum-induced changes in primary human tubular epithelial cells cultured in 3D microphysiological devices. Serum proteins induced cellular proliferation, cytokine secretion and activated a coordinated stress response. We orthogonally confirmed our findings by comparing the transcriptomic and epigenomic landscapes of intact human kidney cortex and isolated tubular epithelial cells cultured in fetal bovine serum. Importantly, key transcriptomic programs in response to either type of serum exposure remained consistent, including comparisons to an established mouse model of kidney injury. This serum-induced transcriptional response was dominated by switching off of nuclear receptor-driven programs and activation of AP-1 and NF-κB signatures in the tubular epigenomic landscape. These features of active regulation were seen at canonical kidney injury genes ( HAVCR1 ) and genes associated with COVID-19 ( ACE2 , IL6 ). Our data provide a reference map for dissecting the regulatory and transcriptional response of kidney tubular epithelial cells injury induced by serum.


Subject(s)
COVID-19 , Glomerulonephritis , Diabetic Nephropathies , Acute Kidney Injury , Neoplasms, Glandular and Epithelial , Kidney Tubular Necrosis, Acute , Proteinuria
20.
Pediatr Nephrol ; 36(4): 1019-1023, 2021 04.
Article in English | MEDLINE | ID: covidwho-1047246

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is thought to cause kidney injury via a variety of mechanisms. The most common reported kidney injury following COVID-19 infection is acute tubular injury (ATI); however, the procoagulant state induced by the virus may also damage the kidneys. CASE-DIAGNOSIS/TREATMENT: Herein, we report two cases of acute necrotizing glomerulonephritis (GN) with fibrinoid necrosis in the context of COVID-19 infection. The one with more chronic features in the kidney biopsy progressed to permanent kidney failure but the second one had an excellent response to glucocorticoid pulse therapy with subsequent normal kidney function at 2-month follow-up. CONCLUSIONS: Both reported cases had an acute presentation of kidney injury with positive nasopharyngeal PCR test for COVID-19. Based on the data review by the researchers, this is the first report of acute necrotizing GN associated with COVID-19 infection.


Subject(s)
Acute Kidney Injury/etiology , COVID-19/complications , Glomerulonephritis/etiology , Kidney Glomerulus/pathology , SARS-CoV-2/pathogenicity , Acute Kidney Injury/pathology , Acute Kidney Injury/therapy , Adolescent , Biopsy , Blood Coagulation , COVID-19/blood , COVID-19/diagnosis , COVID-19/virology , Glomerulonephritis/pathology , Glomerulonephritis/therapy , Glucocorticoids/administration & dosage , Humans , Kidney Glomerulus/blood supply , Male , Necrosis/immunology , Necrosis/pathology , Platelet Count , Pulse Therapy, Drug , Renal Dialysis , SARS-CoV-2/isolation & purification , Treatment Outcome
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