CHANGE IN GLOMERULAR DISEASE PATTERN BEFORE AND AFTER COVID-19 PANDEMIC: EXPERIENCE OF 2 TERTIARY CARE CENTRES IN RAJASTHAN, INDIA

Introduction:

The COVID-19 pandemic posed a significant risk of morbidity and mortality. Kidney injury can occur in up to 40% of patients. Several glomerular diseases have been associated with COVID-19, some related to COVID-19 and some coincidental. Glomerular diseases that are likely to have a causal relationship with COVID-19 have plausible mechanistic explanations such as immune dysregulation, autoantibody production, cytokine upregulation, complement activation, or direct viral toxicity. COVID-19 leads to considerable long-term changes in the immune system, even in mild cases. Hence, in our study we assess the change in glomerular disease pattern in two tertiary centres in India.

Methods:

A total of 750 patients were included in the study from 2 tertiary centres of Rajasthan(AIIMS Jodhpur and R.N.T. Medical College and Hospital, Udaipur) from 2016-2023 (2016-19 being  Pre-COVID and 2020-23 being Post-COVID. Demographic data, along with clinical presentation and renal biopsy findings of the patients were obtained. The kidney biopsy was studied using light microscopy and immunofluorescence (electron microscopy was not done). The change in glomerular pattern was studied concerning age, gender, and primary and secondary causes in pre and post-COVID times.

Results:

A total of 750 biopsies were studied with a mean age of 36.83±14.34 yrs. 54.1% (406) were males and 45.9% (344) were females. 68.4% biopsies were done post-COVID-19 and 63.9% of cases were of primary GN. Overall, FSGS was most prevalent, followed by MN in Primary GN, and Lupus nephritis, followed by amyloidosis, was prevalent in secondary GN. In the pre and post-COVID time, the mean age of glomerular disease was same (36.15±14.02 vs 37.14 ± 14.48; p-value=0.458). However, an increase in glomerular diseases in females was seen in post-COVID-19 (40.51% vs. 48.34%; p=0.048) and there was an increase in secondary GN (28.27% vs. 39.77%; p=0.02).  In primary GN, there was an increase in MN (9.3% vs. 15.4%; p <0.001) and IgA N (2.5% vs. 8.4%; p<0.001) and in secondary GN, there is an increase in RCN (0.84% vs 7.0%; p<0.001) and crescentic GN (2.95% vs. 6.4%; p<0.001) post-COVID-19.

Conclusions:

There was a change in glomerular disease pattern from pre-COVID to post-COVID. Secondary GN increased, with a higher prevalence in females, and antibody and immune complex-mediated GN increased in particular in our study.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.