Abstract: PUB354
Beyond the Virus: A Case Report on Tip Lesion Variant of FSGS after COVID-19 Infection
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Chahil, Manpreet, Kent Hospital, Warwick, Rhode Island, United States
- Kruger Gomes, Larissa, Kent Hospital, Warwick, Rhode Island, United States
- Stokes, Michael Barry, Columbia University, New York, New York, United States
Introduction
Focal segmental glomerulosclerosis (FSGS) is one of the most common causes of nephrotic syndrome and has been seen asociated with COVID-19 infection and vaccination. FSGS is a pattern of glomerular injury seen at the glomerular visceral epithelial cell (the podocyte) level and defined as the presence of sclerosis in parts of some glomeruli. Appropriate therapy is based on the classification of the FSGS lesion into either primary, secondary, genetic, or undeterminate forms.
Case Description
A 72-year-old male with history of DVT and PE (on Xarelto) presented to the hospital with progressively worsening diffuse body swelling, dyspnea, and fatigue developing over the course of one month in the setting of prior COVID-19 infection 4 weeks ago. Initial vital signs on arrival revealed elevated BP 172/103 but otherwise the patient was hemodynamically stable. Initial chest x-ray revealed trace right and left small pleural effusions. Initial BMP was notable for creatinine elevated at 1.84, BUN 66, and K 5.9. Urinalysis revealed >500 protein, 2+ blood. Initial urine studies were suspicious for nephrotic syndrome given total urine protein >4000 g/dL and urine creatinine 376.6 mg/dL. Further work-up during admission revealed negative SPEP and UPEP, normal C2 and C3, negative p-ANCA and c-ANCA, and nonreactive hepatitis A, B, and C antibodies. Renal ultrasound was negative. Kidney biopsy revealed FSGS tip variant; patchy acute tubular injury; minimal tubular atrophy and interstitial fibrosis; mild arterio- and arteriosclerosis. Following results of kidney biopsy, the patient was started on high dose steroids.
Discussion
It is important to recognize post-COVID Renal Syndrome to raise awareness for conditions such as FSGS which are steroid responsive to further assist in diagnosing renal complications earlier in patients who present with nephrotic range proteinuria post COVID infection. Literature review has revealed cases on tip-variant FSGS being one of the most frequent FSGS variants associated with COVID vaccination and post-COVID infection. By understanding the pathophysiological mechanisms underlying renal involvement post-COVID, including direct viral invasion, immune-mediated injury, and endothelial dysfunction, this report highlights the complexity of renal manifestations in the context of viral infections.