We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Glucocorticoids Induce Partial Remission of Focal Segmental Glomerulosclerosis but Not Interstitial Nephritis in COVID-19 Acute Kidney Injury in an APOL1 Low-Risk Genotype White Patient.
- Authors
Nowak, Piotr J.; Forycka, Joanna; Cegielska, Natalia; Harendarz, Karolina; Wągrowska-Danilewicz, Małgorzata; Danilewicz, Marian; Płoszaj, Tomasz; Borowiec, Maciej; Wlazeł, Rafał; Nowicki, Michał
- Abstract
Patient: Male, 34-year-old Final Diagnosis: Focal segmental glomerulosclerosis Symptoms: Acute kidney injury-nephrotic syndrome Medication: -- Clinical Procedure: Kidney biopsy Specialty: Nephrology Objective: Rare coexistence of disease or pathology Background: COVID-19 can be complicated by kidney disease, including focal segmental glomerulosclerosis (FSGS), interstitial nephritis, and acute kidney injury (AKI). Almost all known cases of COVID-19-associated glomerulonephritis have been in patients of African descent, with G1 or G2 apolipoprotein L1 (APOL1) risk alleles, and they presented collapsing type of FSGS. Case Report: We report a case of biopsy-confirmed non-collapsing FSGS with secondary acute interstitial nephritis and AKI in a young White man with APOL1 low-risk genotype, who had COVID-19 pneumonia. His past history included arterial hypertension, anabolic steroids, and high-protein diet. He fully recovered from type 1 respiratory failure and AKI after transfusion of COVID-19 convalescent plasma and intravenous treatment with dexamethasone administered for 16 days in a dose reduced from 16 to 2 mg/day. Due to progressing severe nephrotic proteinuria (22.6 g/24 h), intravenous methylprednisolone was administered (1500 mg divided in 3 pulses over 3 days) immediately followed by oral prednisone (0.6 mg/kg body weight), with dose reduced 19 weeks later and switched to cyclosporine A (4 mg/kg body weight). Kidney re-biopsy, at that time, showed a decrease in proportion of glomeruli affected with podocytopathy, but progression of interstitial lesions. After 23 weeks of therapy, partial remission of FSGS was attained and proteinuria dropped to 3.6 g/24 h. After 43 weeks, proteinuria decreased to 0.4 g/24 h and the serum creatinine concentration remained steady. Conclusions: High-dose glucocorticoid therapy was effective in the initial treatment of COVID-19-related non-collapsing FSGS, but had no effect on interstitial changes. Introduction of cyclosporine A to the therapy contributed to remission of disease.
- Subjects
ACUTE kidney failure; FOCAL segmental glomerulosclerosis; COVID-19; INTERSTITIAL nephritis; PATHOLOGY; CONVALESCENT plasma; DRUGS
- Publication
American Journal of Case Reports, 2021, Vol 22, p1
- ISSN
1941-5923
- Publication type
Case Study
- DOI
10.12659/AJCR.933462