Internal Medicine, Indiana University School of Medicine Muncie, Muncie, USA.
Department of Pathology, Indiana University, Indianapolis, USA.
J Med Case Rep. 2023 Apr 7;17(1):153. doi: 10.1186/s13256-023-03888-z.
Acute kidney injury is now recognized as a common complication of coronavirus disease 2019, affecting up to 46% of patients, with acute tubular injury as the most common etiology. Recently, we have seen an increase in cases of collapsing glomerulonephritis in patients with coronavirus disease 2019, also known as coronavirus disease 2019-associated nephropathy. It has been noted to be seen with a higher incidence in African American patients who are carriers of the APOL1 variant allele.
A 47-year-old African American male with a past medical history of asthma presented to the emergency department with complaints of intermittent chest pain, shortness of breath, and worsening confusion. On admission, he was found to be hemodynamically stable, but labs were significant for elevated creatinine and blood urea nitrogen, signifying acute kidney injury. He was admitted and taken for emergent dialysis. During his hospitalization, he was found to be positive for coronavirus disease 2019. Renal biopsy was done, which showed collapsing glomerulopathy, and the patient continues to require outpatient dialysis after discharge.
Collapsing glomerulonephritis has emerged as a complication in patients with coronavirus disease 2019. This condition should be particularly suspected in African American patients who present with acute kidney injury, nephrotic-range proteinuria, and who are positive for coronavirus disease 2019. Current treatment options are limited to supportive treatment and renal replacement therapy. More clinical cases and trials are needed to better understand and improve therapeutic outcomes in these patients.
急性肾损伤现在被认为是 2019 冠状病毒病的常见并发症，高达 46%的患者受到影响，急性肾小管损伤是最常见的病因。最近，我们看到 2019 冠状病毒病患者中肾小球肾炎的病例增多，也称为 2019 冠状病毒病相关肾病。据报道，这种疾病在携带 APOL1 变异等位基因的非裔美国患者中发病率更高。
一名 47 岁的非裔美国男性，既往有哮喘病史，因间歇性胸痛、呼吸急促和意识障碍加重到急诊科就诊。入院时，他血流动力学稳定，但实验室检查显示肌酐和血尿素氮升高，表明急性肾损伤。他被收治并接受紧急透析。在住院期间，他被检测出 2019 冠状病毒病阳性。进行了肾脏活检，显示出塌陷性肾小球病，患者出院后仍需要门诊透析。
塌陷性肾小球肾炎已成为 2019 冠状病毒病患者的一种并发症。在出现急性肾损伤、肾病范围蛋白尿且 2019 冠状病毒病阳性的非裔美国患者中，应特别怀疑这种情况。目前的治疗选择仅限于支持治疗和肾脏替代疗法。需要更多的临床病例和试验来更好地了解和改善这些患者的治疗结果。
