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

Nastaran Daneshgar; Peir-In Liang; Christina J. Michels; Carla M. Nester; Lyndsay A. Harshman; Dao-Fu Dai

doi:10.3389/fped.2022.827466

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

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

Nastaran Daneshgar, Peir-In Liang, Christina J. Michels, Carla M. Nester, Lyndsay A. Harshman and Dao-Fu Dai

Frontiers in pediatrics, Vol.10, 827466

03/01/2022

DOI: 10.3389/fped.2022.827466

PMCID: PMC8931284

PMID: 35311055

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Abstract

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.

case report

COVID-19

cryoglobulinemia

glomerulonephropathy

kidney transplant

membranoproliferative glomerulonephritis (MPGN)

Details

Title: Subtitle: Case Report: Clinical and Pathological Findings of a Recurrent C3 Glomerulopathy With Superimposed Membranoproliferative Glomerulonephritis Pattern and Cryoglobulinemia Associated With COVID-19
Creators: Nastaran Daneshgar - University of Iowa
Peir-In Liang - Kaohsiung Medical University
Christina J. Michels - University of Iowa
Carla M. Nester - University of Iowa
Lyndsay A. Harshman - University of Iowa
Dao-Fu Dai - University of Iowa
Resource Type: Journal article
Publication Details: Frontiers in pediatrics, Vol.10, 827466
DOI: 10.3389/fped.2022.827466
PMID: 35311055
PMCID: PMC8931284
NLM abbreviation: Front Pediatr
eISSN: 2296-2360
Publisher: Frontiers Media S.A
Grant note: DOI: 10.13039/100000002, name: National Institutes of Health
Language: English
Date published: 03/01/2022
Academic Unit: Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics; Pathology; Iowa Neuroscience Institute; Radiation Oncology; Internal Medicine
Record Identifier: 9984227003002771

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