Case Report: Clinical and Pathological Findings of a Recurrent C3 Glomerulopathy With Superimposed Membranoproliferative Glomerulonephritis Pattern and Cryoglobulinemia Associated With COVID-19

Frontiers in Pediatrics

article

Nastaran Daneshgar¹  Peir-In Liang¹  Christina J. Michels³  Carla M. Nester³  Lyndsay A. Harshman³  Dao-Fu Dai¹ 

[1] Department of Pathology, Carver College of Medicine, University of Iowa;Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University;Division of Pediatric Nephrology, University of Iowa Stead Family Department of Pediatrics, University of Iowa;Molecular Otolaryngology and Renal Research Laboratories, Carver College of Medicine, University of Iowa

关键词: COVID-19;    glomerulonephropathy;    cryoglobulinemia;    case report;    kidney transplant;    membranoproliferative glomerulonephritis (MPGN);    C3 glomerulopathy (C3G);   

DOI  :  10.3389/fped.2022.827466

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Coronavirus disease 2019 (COVID-19) may cause a wide spectrum of kidney pathologies. The impact of COVID-19 is unclear in the context of the complement system abnormalities, including C3 glomerulopathy (C3G). In this report, we describe a young adult receiving a kidney transplant for C3 glomerulopathy (C3G), a disorder of the alternative complement pathway. The patient developed a recurrent C3G ~7 months after transplantation. His post-transplant course was complicated by SARS-CoV-2 infection. There was a progression of glomerulonephritis, characterized by de novo immune-complex mediated membranoproliferative glomerulonephritis pattern of injury with crescentic and necrotizing features, along with positive immunoglobulins, persistent IgM staining and the presence of cryoglobulinemia. COVID-19 may have aggravated the inherent complement dysregulation and contributed to cryoglobulinemia observed in this patient. Our study of 5 sequential kidney allograft biopsy series implicates that COVID-19 in this patient promoted a superimposed immune complex-mediated glomerulonephritis with membranoproliferative glomerulonephritis (MPGN) pattern and cryoglobulinemia, which was a potentiating factor in allograft loss. This work represents the first report of cryoglobulinemic GN after COVID-19.

【 授权许可】

CC BY