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Case Reports
. 2021 Mar 31;13(4):587.
doi: 10.3390/v13040587.

IgA-Dominant Infection-Associated Glomerulonephritis Following SARS-CoV-2 Infection

Aurora Pérez  1 , Isidro Torregrosa  1 , Luis D'Marco  1 , Isabel Juan  1 , Liria Terradez  2 , Miguel Ángel Solís  1 , Francesc Moncho  1 , Carmen Carda-Batalla  2 , María J Forner  3 , Jose Luis Gorriz  1
Affiliations
Case Reports

IgA-Dominant Infection-Associated Glomerulonephritis Following SARS-CoV-2 Infection

Aurora Pérez et al. Viruses. .

Abstract

The renal involvement of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported. The etiology of kidney injury appears to be tubular, mainly due to the expression of angiotensin-converting enzyme 2, the key joint receptor for SARS-CoV-2; however, cases with glomerular implication have also been documented. The multifactorial origin of this renal involvement could include virus-mediated injury, cytokine storm, angiotensin II pathway activation, complement dysregulation, hyper-coagulation, and microangiopathy. We present the renal histological findings from a patient who developed acute kidney injury and de novo nephrotic syndrome, highly suggestive of acute IgA-dominant infection-associated glomerulonephritis (IgA-DIAGN) after SARS-CoV-2 infection, as evidenced by the presence of this virus detected in the renal tissue of the patient via immunohistochemistry assay. In summary, we document the first case of IgA-DIAGN associated to SARS-CoV-2. Thus, SARS-CoV-2 S may act as a super antigen driving the development of multisystem inflammatory syndrome as well as cytokine storm in patients affected by COVID-19, reaching the glomerulus and leading to the development of this novel IgA-DIAGN.

Keywords: COVID-19; SARS-CoV-2; acute kidney injury; glomerulonephritis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) (10×) (B) (20×) (C) (40×) H.E: Glomeruli with endocapillary proliferation, observing collapsed vascular lumens and increased cellularity with isolated neutrophils (white arrow) and nuclear fragments (*). Thrombi are not observed; (D) (20×), HE: Tubules with isometric cytoplasmic vacuolization, (E) (10×) (F) (40×) Trichrome stain: erythrocytes in peritubular capillaries and solitary glomerular hyaline thrombus (yellow arrow).
Figure 2
Figure 2
Direct immunofluorescence study showing predominant IgA positivity (A) and C3 positivity (B) with granular pattern and mesangial distribution.
Figure 3
Figure 3
Electron-dense deposits with mesangial and para-mesangial location (A). Viral particles with a double contour membrane and a crown of 120 nm diameter in podocyte cytoplasm (arrows) (B,C).
Figure 4
Figure 4
(A) (10×), (B) (20×): Positive immunostain for SARS-CoV-2 with a granular cytoplasmic pattern in tubular epithelial cells.
See this image and copyright information in PMC

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