Iga nephropathy post COVID-19 infection

ABSTRACT

Introduction: Acute kidney injury (AKI) occurs in > 20% of hospitalized patients with SARS-CoV2 infection. Etiology of renal injury includes acute tubular injury, collapsing focal segmental glomerulosclerosis, and thrombotic microangiopathy. Rarely COVID-19 has been associated with antineutrophil cytoplasmic antibody associated vasculitis, anti-glomerular basement membrane antibody disease, and IgA nephropathy. We report a case of crescentic IgA nephropathy in a patient with recent COVID-19 infection. Case Description A 55-year-old man with prolonged hospitalization for COVID-19 complicated by pulmonary embolism presented with hemorrhage secondary to a spontaneous retroperitoneal bleed. On admission, he was hemodynamically stable but received large-volume blood product transfusion. Significant admission labs included serum creatinine 3.54 mg/dl (baseline 1.34mg/dl), urinalysis with large blood and protein, spot urine protein to creatinine ratio 6,697 mg/g. Renal function and hemoglobin continued to decline despite stabilization of his bleed. Hemolysis workup revealed haptoglobin <10, lactate dehydrogenase 714, occasional schistocytes on the peripheral blood smear, concerning for TMA secondary to COVID-19 infection. Renal biopsy revealed crescentic IgA nephropathy with moderate acute tubular injury. He was started on prednisone 80mg daily for crescentic IgA nephropathy. Unfortunately his kidney function continued to worsen, and renal replacement therapy was initiated. He continued to require dialysis while inpatient with no meaningful renal recovery. Discussion: AKI is a common complication in COVID-19, however, this is not typically due to glomerular disease. Although viral infections such as COVID-19 can trigger IgA nephropathy, to the best of our knowledge, there is only one other case report of IgA nephropathy in a patient with a COVID-19 infection. COVID-19 associated glomerular disease, including IgA nephropathy, should be considered in patients with nephrotic range proteinuria, and hematuria in the setting of recent COVID-19 infection.