Membranous nephropathy in a patient with coronavirus disease 2019 (COVID-19): A case report

Abstract

Introduction: Though respiratory, immune, and coagulation systems are major targets of coronavirus disease 2019 (COVID-19), kidney dysfunction, presenting with acute kidney injury (AKI), is also common. Most AKI cases in COVID-19 manifest as acute tubular injury (ATI) in conjunction with multiorgan failure. While initial renal pathological findings were limited to acute tubular necrosis and collapsing glomerulopathy, a recent case series reported a larger spectrum of findings. Case report: Here, we report a case of membranous nephropathy (MN) in an 81-year-old Hispanic man with underlying chronic kidney disease (CKD) stage 3 who developed ATI in the setting of COVID-19. The patient was hospitalized for hypoxic respiratory failure in the setting of AKI stage 3 with serum creatinine 7.1 mg/dL 6 days after a positive-SARS-CoV-2 screening. He was found to have nephrotic range proteinuria, glycosuria (with normal serum glucose), anemia, and hypoalbuminemia. Kidney biopsy showed ATI and early MN. Workup for primary and secondary MN was unrevealing, and serum PLA2R antibody was negative. No viral particles were observed in podocytes. Conclusion: Although the MN could be incidental, this observation raises the question of whether SARS-CoV-2 infection can trigger or worsen an underlying MN from an exaggerated immune response associated with COVID-19.

A case of membranous nephropathy following Pfizer–BioNTech mRNA vaccination against COVID-19

“…Our observation, together with other case reports of MN development post COVID-19 infection 2,3 and MN relapse post COVID-19 vaccine 1 , supports a possible immune dysregulation process causing loss of tolerance to certain podocyte antigens, which requires further studies to elucidate.…”

COVID-19 and kidney disease: insights from epidemiology to inform clinical practice

“…A number of case reports suggest that COVID-19 may induce de novo immune-mediated kidney diseases such as IgA nephropathy 92 , vasculitis 93 , membranous nephropathy 94 , minimal change disease 95 and collapsing focal segmental glomerulosclerosis 96 , 97 . Larger studies are needed to quantify the extent of these associations by comparing, for example, the incidence of specific kidney diseases before and after the pandemic within histopathology registries 98 .…”

Spectrum of Kidney Injury Following COVID-19 Disease: Renal Biopsy Findings in a Single Italian Pathology Service

“…Several conditions could lead to ATN, but two significant groups were usually described: (1) ischemia-related, as observed during marked hypotension/shock conditions, such as acute pancreatitis and trauma, and (2) nephrotoxic-related agents (e.g., drugs (gentamycin, cisplatin, methotrexate), hemoglobin, myoglobin). As per the COVID-19 infection, ATN nowadays represents a well-described complication of COVID-19 hospitalized patients and the most common histomorphological pattern leading to AKI [ 101 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 ]. In our series, we observed a relevant rate of ATN in different phases (from active necrosis to later regenerative stages), and, according to the literature, it was the main pattern related to AKI.…”