Chandok Taruna, Nasr Rabih, Uday Kalpana A
Internal Medicine, Bronx Care Health System, Bronx, USA.
Nephrology, Bronx Care Health System, Bronx, USA.
Cureus. 2023 Feb 15;15(2):e35006. doi: 10.7759/cureus.35006. eCollection 2023 Feb.
Vasculitis, or inflammation of blood vessels, is commonly seen with severe acute respiratory syndrome Coronavirus disease 2 (SARS-CoV-2). It is usually triggered by an autoimmune response induced by the virus, infection by the virus itself and trauma to the epithelial vessels caused by the release of cytokines. We present a case of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (pauci-immune crescentic glomerulonephritis [GN]) superimposed on acute kidney injury caused by SARS-CoV-2. Our patient is a 57-year-old Hispanic female who presented with rising creatinine and active urinary sediment in the setting of an asymptomatic COVID-19 infection. A kidney biopsy was done for declining renal function, and positive myeloperoxidase antibodies revealed pauci-immune focal crescentic glomerulonephritis. Normalization of renal function was not achieved with pulse steroids and rituximab. The patient required long-term hemodialysis. Our case here adds to the very few cases of pauci-immune crescentic glomerulonephritis reported in patients with asymptomatic SARS-CoV-2 infection. We recommend keeping this high on the differential in SARS-CoV-2-infected patients presenting with acute kidney injury.
血管炎，即血管的炎症，在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染中很常见。它通常由病毒诱导的自身免疫反应、病毒本身的感染以及细胞因子释放导致的上皮血管损伤引发。我们报告一例抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（寡免疫性新月体性肾小球肾炎[GN]）叠加在SARS-CoV-2引起的急性肾损伤上的病例。我们的患者是一名57岁的西班牙裔女性，在无症状的COVID-19感染背景下出现肌酐升高和活动性尿沉渣。因肾功能下降进行了肾活检，髓过氧化物酶抗体阳性显示为寡免疫性局灶性新月体性肾小球肾炎。使用脉冲类固醇和利妥昔单抗未能使肾功能恢复正常。患者需要长期血液透析。我们这里的病例增加了无症状SARS-CoV-2感染患者中报告的极少数寡免疫性新月体性肾小球肾炎病例。我们建议对于出现急性肾损伤的SARS-CoV-2感染患者，将其列为高度可疑诊断。
