A Novel Association Between Coronavirus Disease 2019 and Normocomplementemic Rapidly Progressive Glomerulonephritis-Crescentic Immunoglobulin A Nephropathy: A Report of Two Pediatric Cases

Abstract

Coronavirus disease 2019 , caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been predominately associated with respiratory illness. Acute kidney injury (AKI) is the most common reported kidney involvement. Kidney complications, including proteinuria, hematuria, and rarely collapsing glomerulopathy (CG), a form of focal segmental glomerulosclerosis (FSGS), are also well known now and are frequently documented in the literature published so far.We present two cases of glomerulonephritis (GN) in the setting of AKI in COVID-19 infection in children. Kidney biopsy specimens showed immunoglobulin A nephropathy (IgAN) with crescentic GN (CGN) with acute tubular injury with focal medium artery vasculitis. The patients exhibited a severe presentation and rapid progression to end-stage renal disease (ESRD). This report attempts to add a bit to the evolving information on COVID-19 disease, especially in children as far as kidney involvement is concerned.

De Novo Crescentic Glomerulonephritis Following COVID-19 Infection: A Pediatric Case Report

“…After a brief follow-up period, the kidney function of none of the patients returned to its baseline level. 2 N et al 3 presented a case of glomerulonephritis in the setting of AKI in a child with COVID-19. Kidney biopsy specimens showed IgA nephropathy with crescentic glomerulonephritis, acute tubular injury, and focal medium-artery vasculitis.…”

Kidney complications associated with COVID-19 infection and vaccination in children and adolescents: a brief review

“…Another case study reported on 2 patients (13- and 16-year-old boys) who developed severe, rapidly progressive GN and end-stage renal disease after COVID-19 in India. A kidney biopsy confirmed immunoglobulin A (IgA) nephropathy with crescentic GN, acute tubular injury, and focal medium-artery vasculitis [ 34 ].…”

Pathogenesis and histological changes of nephropathy associated with COVID‐19

“…133 (G, H) In SARS-COV-2-related Immunoglobulin A (IgA) nephropathy, the glomeruli manifested as necrotizing lesions and crescent formation (PAS), 134 and IgA was deposited in the mesangial area of the glomerulus. 135 syndrome, and concomitant hemolytic uremic syndrome, vasculitis, and acute necrotizing glomerulonephritis.…”

“…It is generally believed that collapsing glomerulopathy is related to ALOP1 gene mutations, and 36% of patients can achieve partially alleviation of the proteinuria 76,132,140 (Figure 3E). Some patients may also develop granulomatous interstitial nephritis 133 (Figure 3F), IgA nephropathy, and glomerulonephritiscrescentic immunoglobulin A nephropathy 134,135 (Figure 3G). There are also rare reports of membranous nephropathy and T A B L E 2 Mechanism and pathological changes of renal parenchymal cell injury caused by SARS-CoV-2…”

“…(F) Granulomatous interstitial nephritis, manifesting as non‐caseating granulomas with interstitial lymphocytes and macrophages (PAS) 133 . (G, H) In SARS‐COV‐2‐related Immunoglobulin A (IgA) nephropathy, the glomeruli manifested as necrotizing lesions and crescent formation (PAS), 134 and IgA was deposited in the mesangial area of the glomerulus 135 …”