Clinical and pathological findings of SARS-CoV-2 infection and concurrent IgA nephropathy: A case report

Background: Since the Coronavirus Disease 2019 (COVID-19) outbreak, there is limited data on the clinical characteristics, treatment strategies and prognosis of COVID-19 in patients with concurrent renal disease. The kidney is believed to have a predisposition for COVID-19 due to its abundant angiotensin-converting enzyme 2 (ACE2) expression, which acts as a cell entry receptor for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent postmortem investigations reveal renal involvement in COVID-19, and case reports describe collapsing glomerulopathy in African American patients with COVID-19. However, there is limited data regarding IgA nephropathy in the setting of COVID-19. Case presentation: In the present case, we report a 65-year old Chinese woman who presented with macroscopic hematuria, worsening proteinuria and decreased renal function after COVID-19 infection. She received a renal biopsy during COVID-19 infection. The renal biopsy revealed IgA nephropathy without any evidence for SARS-Cov-2. The findings suggest that the renal abnormalities were a consequence of exacerbation of this patient’s underlying glomerular disease after COVID-19 infection. After a regimen of 3-day course of glucocorticoid and angiotensin II receptor blocker therapy, the patient recovered and remained stable upon follow-up. Conclusions: : It is important to consider the underlying glomerular disease exacerbation rather than virus induced injury when dealing with renal abnormalities in patients with COVID-19.