Case Report: Clinical and Pathological Findings of a Recurrent C3 Glomerulopathy With Superimposed Membranoproliferative Glomerulonephritis Pattern and Cryoglobulinemia Associated With COVID-19.
Case Report: Clinical and Pathological Findings of a Recurrent C3 Glomerulopathy With Superimposed Membranoproliferative Glomerulonephritis Pattern and Cryoglobulinemia Associated With COVID-19.
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DOI：
10.3389/fped.2022.827466
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发表时间：
2022
影响因子：
2.6
通讯作者：
Dai DF
中科院分区：
文献类型：
--
作者：
Daneshgar N;Liang PI;Michels CJ;Nester CM;Harshman LA;Dai DF
2019冠状病毒病（COVID-19）可能导致广泛的肾脏病理。在补体系统异常（包括C3肾小球病（C3 G））的背景下，COVID-19的影响尚不清楚。在这份报告中，我们描述了一个年轻的成年人接受肾移植的C3肾小球病（C3 G），一种疾病的替代补体途径。患者在移植后约7个月出现复发性C3 G。他的移植后病程因SARS-CoV-2感染而复杂化。肾小球肾炎进展，特征为新发免疫复合物介导的膜增生性肾小球肾炎损伤模式，伴新月体和坏死特征，沿着免疫球蛋白阳性、持续IgM染色和存在冷球蛋白血症。COVID-19可能加重了固有的补体失调，并导致在该患者中观察到的冷球蛋白血症。我们对5个连续肾移植活检系列的研究表明，该患者的COVID-19促进了免疫复合物介导的肾小球肾炎与膜增殖性肾小球肾炎（MPGN）模式和冷球蛋白血症的叠加，这是移植物丢失的增强因素。这项工作代表了COVID-19后第一份关于冷球蛋白血症GN的报告。
Coronavirus disease 2019 (COVID-19) may cause a wide spectrum of kidney pathologies. The impact of COVID-19 is unclear in the context of the complement system abnormalities, including C3 glomerulopathy (C3G). In this report, we describe a young adult receiving a kidney transplant for C3 glomerulopathy (C3G), a disorder of the alternative complement pathway. The patient developed a recurrent C3G ~7 months after transplantation. His post-transplant course was complicated by SARS-CoV-2 infection. There was a progression of glomerulonephritis, characterized by de novo immune-complex mediated membranoproliferative glomerulonephritis pattern of injury with crescentic and necrotizing features, along with positive immunoglobulins, persistent IgM staining and the presence of cryoglobulinemia. COVID-19 may have aggravated the inherent complement dysregulation and contributed to cryoglobulinemia observed in this patient. Our study of 5 sequential kidney allograft biopsy series implicates that COVID-19 in this patient promoted a superimposed immune complex-mediated glomerulonephritis with membranoproliferative glomerulonephritis (MPGN) pattern and cryoglobulinemia, which was a potentiating factor in allograft loss. This work represents the first report of cryoglobulinemic GN after COVID-19.
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