Immunoglobulin-A Vasculitis With Renal Involvement in a Patient With COVID-19: A Case Report and Review of Acute Kidney Injury Related to SARS-CoV-2
| Autor: | Adam B Papini, Tiffany Shao, Nicholas L. Li, Louis Girard |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Immunoglobulin A
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Case Report urologic and male genital diseases lcsh:RC870-923 IgA vasculitis Medicine medicine.diagnostic_test biology business.industry SARS-CoV-2 Acute kidney injury COVID-19 Glomerulonephritis medicine.disease lcsh:Diseases of the genitourinary system. Urology acute kidney injury Nephrology Immunology biology.protein Renal biopsy business Complication Vasculitis glomerulonephritis |
| Zdroj: | Canadian Journal of Kidney Health and Disease, Vol 8 (2021) Canadian Journal of Kidney Health and Disease |
| ISSN: | 2054-3581 |
| Popis: | Rationale: Acute kidney injury is a common complication of COVID-19 and is associated with significantly increased mortality. The most frequent renal biopsy finding with SARS-CoV-2 infection is acute tubular injury; however, new onset glomerular diseases have been reported. The development of persistent urinary abnormalities in patients with COVID-19 should prompt consideration for renal biopsy to rule out glomerulonephritis. Presenting Concerns: A 30-year-old man with no prior medical history presented to the emergency department with symptoms of COVID-19 and new onset painful purpuric rash, arthralgia, and abdominal pain. SARS-CoV-2 infection was confirmed with nucleic acid testing and laboratory investigations revealed preserved renal function with dysmorphic hematuria and nephrotic range proteinuria. Diagnosis: A skin biopsy of the purpuric rash was performed, which demonstrated leukocytoclastic vasculitis. Renal biopsy revealed focally crescentic and segmentally necrotizing IgA nephropathy. Overall, given the clinical syndrome of glomerulonephritis with purpuric rash, arthralgia, and abdominal pain, the presentation is most in keeping with a diagnosis of IgA vasculitis in the setting of COVID-19. Interventions: The patient was treated conservatively for COVID-19 in the community. A 7-day course of prednisone was started for the vasculitic rash. IgA nephropathy was managed conservatively with blood pressure control and RAAS blockade with losartan. Outcomes: With conservative management, the patient’s COVID-19 symptoms resolved completely and he did not require hospital admission. Following prednisone therapy, the patient’s rash, arthralgia, and abdominal pain improved. However, despite resolution of COVID-19, hematuria and proteinuria persisted. With the initiation of RAAS blockade, renal function remained stable and proteinuria improved dramatically at 6 weeks. Novel Findings: De novo glomerulonephritis is a renal manifestation of SARS-CoV-2 infection beyond acute tubular injury. IgA vasculitis appears to be a rare complication of COVID-19. |
| Databáze: | OpenAIRE |
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