De novo collapsing glomerulopathy in a pediatric kidney transplant recipient with COVID-19 infection

© 2021 Wiley Periodicals LLC..

The negative impact of COVID-19 on adults with underlying chronic kidney disease, including kidney transplant recipients, has been well documented. Children have a less severe presentation and better prognosis compared to adults. However, little is known regarding the spectrum of COVID-19 infection in children and adolescents with underlying autoimmune disorders necessitating solid organ transplant and long-term immunosuppressive therapy. Case Report. An adolescent male developed end-stage kidney disease secondary to microscopic polyangiitis requiring a living-donor kidney transplant. Six years later, he developed antibody-mediated rejection of his kidney transplant. During his rejection treatment course, he contracted SARS-CoV-2 and developed new-onset nephrotic syndrome with severe acute kidney injury. Kidney transplant biopsy revealed de novo collapsing focal segmental glomerulosclerosis on a background of chronic active antibody mediated rejection. Immunostaining for SARS-CoV-2 on the biopsy specimen demonstrated positive staining of the proximal tubular epithelium consistent with intra-renal viral infection. Pulse corticosteroids, intravenous immunoglobulin, and temporary reduction of anti-metabolite therapy resulted in successful recovery with return of graft function back to pre-infection baseline. This case highlights the clinical conundrum of treating kidney transplant recipients with active rejection in the midst of the COVID-19 pandemic. Pediatric kidney transplant recipients can develop severe COVID-19-related kidney complications. Judicious immunosuppression modulation is necessary to balance infection and rejection risk.

Media Type:

Electronic Article

Year of Publication:

2021

Contained In:

Pediatric transplantation - Vol. 25, No. 4 (2021), p. e14013

Language:

English

Contributors:

Levenson, Emma
Shepherd, Tara N
Aviles, Diego
Craver, Randall
Ehlayel, Abdulla
Love, Gordon L
Simms, K'Joy
Straatmann, Caroline
Ashoor, Isa F

Urls:

Volltext

Keywords:

*Kidney Transplantation
Acute kidney injury
Adolescent
COVID
COVID-19
Case Reports
Glomerular disease
Glomerulosclerosis, Focal Segmental
Humans
Journal Article
Kidney transplant
Male
Postoperative Complications

Notes:

Date Completed 03.06.2021

Date Revised 03.06.2021

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1111/petr.14013

PMID:

33773007

PPN (Catalogue-ID):

NLM324376510