COLLAPSING GLOMERULOPATHY AND NEPHRECTOMY IN THE AFTERMATH OF COVID-19. CASE REPORT.

Introduction:

Collapsing glomerulopathy (CG) is a rare podocytopathy characterized by segmental collapse of the glomerulus, with hypertrophy and hyperplasia of the podocytes. Some cases have been reported in the aftermath of coronavirus disease 2019 (COVID-19). We present the case of a patient with CG who underwent nephrectomy after COVID-19.

Methods:

CASE PRESENTATION

Previously healthy 46-year-old Hispanic male. He had confirmed mild COVID-19 in 2022; 15 days later he presented with hypertensive urgency and macroscopic hematuria. Urology suspected a malignant cause and performed right nephrectomy. Pathology reported nephrocalcinosis and moderate chronic interstitial nephritis.

He was referred to nephrology in 2024 because of subnephrotic proteinuria (24 h creatinine clearance 22.11 mL/min, 24 h total proteins 1.49 g/day, serum creatinine 5.66 mg/dL, cystatin C 3.96 mg/L, eGFR Cr/Cys 12 ml/min 1.73 m2). Biochemical evaluation was normal (table 1). Left renal ultrasonography revealed a 115.9 x 44.6 x 56.5 mm kidney with regular contours, homogeneous parenchyma, 10 mm cortex, preserved vascularity and a renal artery RI of 0.58.

Percutaneous renal biopsy was performed without incidents. 24 h later, a simple CT scan revealed a 39 x 69 mm retroperitoneal hematoma. Angiography revealed an anomalous arterial phase staining in the mid-anterior segment and embolization was performed (picture 1).

Results:

Pathology reported renal parenchyma, predominantly cortex, as well as 19 glomeruli, 26.31% globally sclerosed and in 21.05% segmental sclerosing scar lesions form synechiae between the capillary tangles and Bowman's capsules, two of these located at the glomerular tip or urinary pole (picture 2). Interstitial fibrosis II (40-50%) was noted. Chronicity was scored as 8/10 (glomerulosclerosis 3/3, tubular atrophy 2/3, interstitial fibrosis 2/3 and angiosclerosis (1/1).

Conclusions:

CG is a podocytopathy characterized by an increase in the focal and segmental mesangial matrix with obliteration and scarring of the capillary lumen. Changes in podocytes may result in cycles of injury and repair, leading to sclerosis. We assumed the podocytopathy in the patient was caused by COVID-19 and nephrectomy. There are only a handful of case reports of CG associated with COVID-19. He also presented a retroperitoneal hematoma, a complication reported in <5-10% of kidney biopsies. He was treated with methylprednisolone, without response. The patient is currently on renal replacement therapy (peritoneal dialysis).

I have no potential conflict of interest to disclose.

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