Abstract: PUB359
Tip Variant of Focal Segmental Glomerulosclerosis in a Patient with COVID-19
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Al Suradi, Haya H., Kent Hospital, Warwick, Rhode Island, United States
- Kruger Gomes, Larissa, Brown University, Providence, Rhode Island, United States
- Stokes, Michael Barry, Columbia University, New York, New York, United States
Introduction
Focal segmental glomerulosclerosis (FSGS) is a clinicopathological syndrome with nephrotic range proteinuria, histology with focal and segmental glomerular sclerosis, and diffuse podocytopathy. FSGS can be classified based on histologic variants into 5 categories, important to recognize for prognostication and treatment options. We present a case of tip variant FSGS with preceding COVID infection.
Case Description
A 72-year-old male with history of provoked DVT and recent COVID infection, he presented with gradually worsening lower limb swelling over the past month. Patient also had bilateral upper limb and abdominal swelling, and exertional dyspnea. On presentation, patient is hypertensive at 172/103, and otherwise hemodynamically stable. Physical examination is notable for bilateral lower and upper limb pitting edema with normal cardiopulmonary exam. CBC is unremarkable. Notable labs showed elevated creatinine at 1.83 mg/dL up from normal baseline 0.98, BUN 66 mg/dL, K 5.9 mmol/L, albumin of 2.1. Due to concern of nephrotic syndrome, urine studies were completed with UPCR 11.07. Additional work-up requested by nephrology included Hba1c, ANCA, HIV, viral hepatitis, SPEP/UPEP & immunofixation, and PLA2R Ab with unremarkable results. Ultimately, the patient underwent renal biopsy showing tip variant FSGS. The patient was started on prednisone 1 mg/kg with improvement in UPCR to 2.71. He has ongoing improvement of proteinuria and symptoms.
Discussion
Tip variant portends the most favorable prognosis with complete remission of FSGS. Our case shows nephrotic range proteinuria after COVID infection that has been described in the literature, although no clear etiology has been found, genetic predisposition has been postulated with viral infections being a second hit. Fortunately, our patient had a favorable response to steroids.
Tip lesion. Endocapillary foam cells (arrow) prolapsing into proximal tubule (*)