Department of Pediatrics, Division of Pediatric Nephrology, University of the Philippines Manila, Manila, Philippines
Department of Laboratory Medicine, National Kidney and Transplant Institute, Quezon City, Philippines.
BMJ Case Rep. 2023 Jan 5;16(1):e251962. doi: 10.1136/bcr-2022-251962.
COVID-19 primarily presents with respiratory involvement. Extrapulmonary manifestations as the sole manifestation also occur although rare. The kidney, being one of the organs with the greatest number of ACE receptors, is usually reported as part of multiorgan involvement. We report an early adolescent boy who presented with nephrotic-nephritic syndrome with severe kidney dysfunction from COVID-19 infection. He had low C3 and undetected antineutrophil cytoplasmic antibodies, antinuclear antibody and antistreptolysin O. Kidney biopsy revealed findings consistent with diffuse proliferative glomerulonephritis with a focal glomerular crescent formation and thin basement nephropathy. Due to the rapidly progressive deterioration of kidney function, he was given pulse methylprednisolone therapy followed by oral prednisone. Complete recovery was documented 12 weeks after the onset of post-infectious glomerulonephritis. The possible pathogenesis of glomerulonephritis in a patient with COVID-19, its differential diagnosis and treatment are discussed.
COVID-19 主要表现为呼吸道受累。虽然罕见，但也会出现以肺外表现为唯一表现的情况。肾脏是 ACE 受体数量最多的器官之一，通常被报告为多器官受累的一部分。我们报告了一名早期青少年男性，他因 COVID-19 感染而出现肾病综合征伴严重肾功能障碍。他的 C3 水平低，且未检测到抗中性粒细胞胞质抗体、抗核抗体和抗链球菌溶血素 O。肾脏活检显示弥漫性增生性肾小球肾炎的表现，伴有局灶性肾小球新月体形成和薄基底膜肾病。由于肾功能迅速恶化，他接受了脉冲甲基强的松龙治疗，随后口服泼尼松。感染后肾小球肾炎发病后 12 周，记录到完全恢复。讨论了 COVID-19 患者肾小球肾炎的可能发病机制、鉴别诊断和治疗。
