De novo collapsing glomerulopathy in a pediatric kidney transplant recipient with COVID-19 infection.

Autor: Levenson E; Department of Pediatrics, LSU Health New Orleans, New Orleans, LA, USA., Shepherd TN; Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA., Aviles D; Division of Nephrology, Department of Pediatrics, LSU Health New Orleans, New Orleans, LA, USA., Craver R; Department of Pathology, LSU Health Science Center, New Orleans, LA, USA., Ehlayel A; Division of Nephrology, Department of Pediatrics, Children's Hospital, New Orleans, LA, USA., Love GL; Department of Pathology, LSU Health Science Center, New Orleans, LA, USA., Simms K; Division of Nephrology, Department of Pediatrics, Children's Hospital, New Orleans, LA, USA., Straatmann C; Division of Nephrology, Department of Pediatrics, LSU Health New Orleans, New Orleans, LA, USA., Ashoor IF; Division of Nephrology, Department of Pediatrics, LSU Health New Orleans, New Orleans, LA, USA.
Jazyk: angličtina
Zdroj: Pediatric transplantation [Pediatr Transplant] 2021 Jun; Vol. 25 (4), pp. e14013. Date of Electronic Publication: 2021 Mar 27.
DOI: 10.1111/petr.14013
Abstrakt: The negative impact of COVID-19 on adults with underlying chronic kidney disease, including kidney transplant recipients, has been well documented. Children have a less severe presentation and better prognosis compared to adults. However, little is known regarding the spectrum of COVID-19 infection in children and adolescents with underlying autoimmune disorders necessitating solid organ transplant and long-term immunosuppressive therapy. Case Report. An adolescent male developed end-stage kidney disease secondary to microscopic polyangiitis requiring a living-donor kidney transplant. Six years later, he developed antibody-mediated rejection of his kidney transplant. During his rejection treatment course, he contracted SARS-CoV-2 and developed new-onset nephrotic syndrome with severe acute kidney injury. Kidney transplant biopsy revealed de novo collapsing focal segmental glomerulosclerosis on a background of chronic active antibody mediated rejection. Immunostaining for SARS-CoV-2 on the biopsy specimen demonstrated positive staining of the proximal tubular epithelium consistent with intra-renal viral infection. Pulse corticosteroids, intravenous immunoglobulin, and temporary reduction of anti-metabolite therapy resulted in successful recovery with return of graft function back to pre-infection baseline. This case highlights the clinical conundrum of treating kidney transplant recipients with active rejection in the midst of the COVID-19 pandemic. Pediatric kidney transplant recipients can develop severe COVID-19-related kidney complications. Judicious immunosuppression modulation is necessary to balance infection and rejection risk.
(© 2021 Wiley Periodicals LLC.)
Databáze: MEDLINE
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