Kidney disease in the aftermath of COVID-19 infection

ABSTRACT

Introduction: COVID-19-associated nephropathy (COVAN) is a known, but potentially missed cause of AKI. We present a case of COVAN presenting with a severe AKI in a previously healthy patient. Case Description A 48-year-old African American male with no known past medical history and a recent COVID-19 infection presented with hypertension and lower extremity edema. Initial work-up showed BUN 60, Cr 4.8. Urinalysis was significant for proteinuria. Urine protein to Cr ratio was 1.4. Renal ultrasound did not show any hydronephrosis. Initial management included blood pressure control and intravenous hydration, and his Cr downtrended to 3.1. Of note, his Cr was 1.2 two weeks prior to admission. Given his acute renal failure and significant proteinuria, a renal biopsy was obtained which showed collapsing FSGS consistent with COVAN. Discussion: Glomerular disease is a known complication of COVID-19. The most distinct presentation is the collapsing FSGS seen in this case (Image 1). This has primarily been reported in patients of African descent, specifically those with high-risk APOL1 genotypes. Patients may recover kidney function, but some may also develop CKD. One month after the hospitalization, this patient's Cr was 4.3 and we suspect he will likely have significant CKD. COVAN can be a difficult diagnosis to make. Proteinuria can often be attributed to common co-morbidities, therefore confounding its diagnosis. The timing also complicates the diagnosis, as in our patient who presented a week after his COVID-19 symptoms resolved. With COVID-19 vaccines, perhaps COVAN may become rarer, but the prevalence and incidence in the era of vaccines must be studied. The longterm repercussions of COVAN are unknown;COVAN should be considered in patients with recent COVID-19 infection presenting with proteinuria. We should make people aware of the possible renal consequences of COVID-19 and sharing this knowledge may help with vaccine hesitancy.