Lessons for the clinical nephrologist: recurrence of nephrotic syndrome induced by SARS-CoV-2

Doevelaar AA, Hölzer B, Seibert FS, Bauer F, Stervbo U, Rohn BJ, Zgoura P, Schenker P, Vonbrunn E, Amann KU, Viebahn R, Babel N, Westhoff TH (2020)

Publication Type: Journal article

Publication year: 2020

Journal

Journal of Nephrology Wichtig Editore

DOI: 10.1007/s40620-020-00855-5

Abstract

SARS-CoV-2 is characterized by a multiorgan tropism including the kidneys. Recent autopsy series indicated that SARS-CoV-2 can infect both tubular and glomerular cells. Whereas tubular cell infiltration may contribute to acute kidney injury, data on a potential clinical correlative to glomerular affection is rare. We describe the first case of nephrotic syndrome in the context of COVID-19 in a renal transplant recipient. A 35 year old male patient received a kidney allograft for primary focal segmental glomerulosclerosis (FSGS). Three months posttransplant a recurrence of podocytopathy was successfully managed by plasma exchange, ivIG, and a conversion from tacrolimus to belatacept (initial proteinuria > 6 g/l decreased to 169 mg/l). Six weeks later he was tested positive for SARS-CoV-2 and developed a second increase of proteinuria (5.6 g/l). Renal allograft biopsy revealed diffuse podocyte effacement and was positive for SARS-CoV-2 in RNA in-situ hybridation indicating a SARS-CoV-2 associated recurrence of podocytopathy. Noteworthy, nephrotic proteinuria resolved spontaneously after recovering from COVID-19. The present case expands the spectrum of renal involvement in COVID-19 from acute tubular injury to podocytopathy in renal transplant recipients. Thus, it may be wise to test for SARS-CoV-2 prior to initiation of immunosuppression in new onset glomerulopathy during the pandemic.

Authors with CRIS profile

Eva Vonbrunn Department of Nephropathology Kerstin Ute Amann Professur für Nephropathologie

Involved external institutions

St. Elisabeth Gruppe GmbH - Katholische Kliniken Rhein-Ruhr DE Germany (DE) Universitätsklinikum Knappschaftskrankenhaus Bochum DE Germany (DE)

How to cite

APA:

Doevelaar, A.A., Hölzer, B., Seibert, F.S., Bauer, F., Stervbo, U., Rohn, B.J.,... Westhoff, T.H. (2020). Lessons for the clinical nephrologist: recurrence of nephrotic syndrome induced by SARS-CoV-2. Journal of Nephrology. https://doi.org/10.1007/s40620-020-00855-5

MLA:

Doevelaar, Adrian A.N., et al. "Lessons for the clinical nephrologist: recurrence of nephrotic syndrome induced by SARS-CoV-2." Journal of Nephrology (2020).

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