Spectrum of podocytopathies in new-onset nephrotic syndrome following COVID-19 disease: a report of 2 cases
Spectrum of podocytopathies in new-onset nephrotic syndrome following COVID-19 disease: a report of 2 cases
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DOI：
10.1186/s12882-020-01970-y
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发表时间：
2020-08-04
期刊：
影响因子：
2.3
通讯作者：
Leggat, John
中科院分区：
文献类型：
--
作者：
Gupta, Rajib K.;Bhargava, Ramya;Leggat, John
2019冠状病毒病（COVID-19）是一种持续的大流行，已影响到全球1200多万人。不同器官系统的表现经常被报道。最近，一些病例报告在已发表的文献中描述了仅以急性肾损伤（AKI）住院的COVID-19患者的肾活检结果。结果包括弥漫性急性肾小管损伤（ATI）和塌陷性肾小球病变（CG）。然而，以肾病综合征作为COVID-19的主诉尚未广泛报道，除CG外的其他肾小球病变也未见报道。我们描述了两例近期诊断为COVID-19并表现为新发肾病综合征的患者的肾活检结果。两例患者的肾活检均显示ATI（如先前报道）和光镜下明显的肾小球发现——一名患者最初为微小病变（MCD），随后活检为CG，另一名患者一开始为CG。两例患者的电镜检查结果均为严重足细胞病变（弥漫性和严重足细胞足突消退）。结论我们的病例强调了一种新的临床表现，即新发肾病综合征，这是以前没有描述过的。虽然所有已发表的病例报告都将CG描述为肾小球病理，但我们在其中一个病例中描述了非CG病理（MCD），从而增加了与COVID-19患者相关的肾脏病理描述。然而，足细胞损伤或足细胞病在所有这些病例中发生的确切机制尚不清楚。目前，这些患者的最佳治疗方案仍然未知。
Background Coronavirus disease-2019 (COVID-19) is an ongoing pandemic which has affected over 12 million people across the globe. Manifestations in different organs systems are being reported regularly. Renal biopsy findings in hospitalized COVID-19 patients presenting solely with acute kidney injury (AKI) have recently been described in published literature in few case reports. The findings include diffuse acute tubular injury (ATI) along with the glomerular lesion of collapsing glomerulopathy (CG). However, nephrotic syndrome as the presenting complaint of COVID-19 has not been reported widely, neither has any other glomerular lesion other than CG. Case presentation We describe the kidney biopsy findings of two patients who had recent diagnoses of COVID-19 and presented with new-onset nephrotic syndrome. Renal biopsy in both patients showed ATI (as in previous reports) and distinct glomerular findings on light microscopy - that of minimal change disease (MCD) initially in one patient followed by CG in a subsequent biopsy and CG at the outset in the other patient. The electron microscopic findings in both patients were that of severe podocytopathy (diffuse and severe podocyte foot process effacement). Conclusion Our cases highlight a novel clinical presentation of COVID-19 renal disease, not described before, that of new-onset nephrotic syndrome. While all published case reports describe CG as the glomerular pathology, we describe a non-CG pathology (MCD) in one of our cases, thereby adding to the repertoire of renal pathology described in association with COVID-19 patients. However, the exact mechanism by which podocyte injury or podocytopathy occurs in all such cases is still unknown. Optimal treatment options for these patients also remains unknown at this time.