Coronavirus disease 2019-associated nephropathy in an African American patient: a case report and review of the literature

Abstract

Background: 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.

Case presentation: 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.

Conclusion: 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.

Keywords: Acute kidney injury; Acute renal failure; COVAN; COVID; COVID-19; Collapsing glomerulopathy; Critical care; ICU.

Fig. 1

Allochrome: glomerulus with collapsing features; including collapse of basement membranes with segmental accentuation and overlying hyaline droplet filled epithelial cells. Active cellular crescents, however, are not seen. Mesangial matrix is mildly expanded. In addition, dilate tubules filled with hyaline and protein casts, loss of brush borders, and intraluminal cellular and granular debris are also seen

Fig. 2

Electron microscopy: one non-obsolescent glomerulus was subjected to ultrastructural examination, with good tissue preservation. Podocytes display widespread effacement of foot processes, which correlates to proteinuria. Glomerular basement membranes are uniformly contoured except for a few segments with mild corrugation (mean glomerular basement membranes thickness, 303 ± 48 nm). Electron dense deposits were not seen