Nowak Piotr J, Forycka Joanna, Cegielska Natalia, Harendarz Karolina, Wągrowska-Danilewicz Małgorzata, Danilewicz Marian, Płoszaj Tomasz, Borowiec Maciej, Wlazeł Rafał, Nowicki Michał
Department of Nephrology Hypertension and Kidney Transplantation, Medical University of Łódź, Łódź, Poland.
Student of Medical Faculty, Medical University of Łódź, Łódź, Poland.
Am J Case Rep. 2021 Nov 2;22:e933462. doi: 10.12659/AJCR.933462.
BACKGROUND COVID-19 can be complicated by kidney disease, including focal segmental glomerulosclerosis (FSGS), interstitial nephritis, and acute kidney injury (AKI). Almost all known cases of COVID-19-associated glomerulonephritis have been in patients of African descent, with G1 or G2 apolipoprotein L1 (APOL1) risk alleles, and they presented collapsing type of FSGS. CASE REPORT We report a case of biopsy-confirmed non-collapsing FSGS with secondary acute interstitial nephritis and AKI in a young White man with APOL1 low-risk genotype, who had COVID-19 pneumonia. His past history included arterial hypertension, anabolic steroids, and high-protein diet. He fully recovered from type 1 respiratory failure and AKI after transfusion of COVID-19 convalescent plasma and intravenous treatment with dexamethasone administered for 16 days in a dose reduced from 16 to 2 mg/day. Due to progressing severe nephrotic proteinuria (22.6 g/24 h), intravenous methylprednisolone was administered (1500 mg divided in 3 pulses over 3 days) immediately followed by oral prednisone (0.6 mg/kg body weight), with dose reduced 19 weeks later and switched to cyclosporine A (4 mg/kg body weight). Kidney re-biopsy, at that time, showed a decrease in proportion of glomeruli affected with podocytopathy, but progression of interstitial lesions. After 23 weeks of therapy, partial remission of FSGS was attained and proteinuria dropped to 3.6 g/24 h. After 43 weeks, proteinuria decreased to 0.4 g/24 h and the serum creatinine concentration remained steady. CONCLUSIONS High-dose glucocorticoid therapy was effective in the initial treatment of COVID-19-related non-collapsing FSGS, but had no effect on interstitial changes. Introduction of cyclosporine A to the therapy contributed to remission of disease.
新型冠状病毒肺炎（COVID-19）可并发肾脏疾病，包括局灶节段性肾小球硬化（FSGS）、间质性肾炎和急性肾损伤（AKI）。几乎所有已知的COVID-19相关性肾小球肾炎病例均发生在非洲裔患者中，这些患者携带G1或G2载脂蛋白L1（APOL1）风险等位基因，且表现为塌陷型FSGS。病例报告：我们报告1例经活检确诊为非塌陷型FSGS并继发急性间质性肾炎和AKI的年轻白人男性病例，该患者携带APOL1低风险基因型，患有COVID-19肺炎。他既往有动脉高血压、使用合成代谢类固醇和高蛋白饮食史。在输注COVID-19康复者血浆并静脉注射地塞米松16天（剂量从16 mg/天减至2 mg/天）后，他从1型呼吸衰竭和AKI中完全康复。由于严重肾病性蛋白尿进展（22.6 g/24小时），立即静脉注射甲泼尼龙（1500 mg分3次脉冲给药，持续3天），随后口服泼尼松（0.6 mg/千克体重），19周后剂量减少并换用环孢素A（4 mg/千克体重）。当时的肾脏再次活检显示，受足细胞病影响的肾小球比例下降，但间质病变进展。治疗23周后，FSGS部分缓解，蛋白尿降至3.6 g/24小时。43周后，蛋白尿降至0.4 g/24小时，血清肌酐浓度保持稳定。结论：大剂量糖皮质激素治疗对COVID-19相关的非塌陷型FSGS初始治疗有效，但对间质变化无效。在治疗中引入环孢素A有助于疾病缓解。
