AN INTERESTING CASE OF MINIMAL CHANGE DISEASE FOLLOWING ACUTE COVID-19 INFECTION
Sanjana Dang1,2,3, Sridevi Govindarajulu2,3 1Princess Alexandra Hospital, Brisbane, QLD, Australia2Toowoomba Base Hospital, Toowoomba, QLD, Australia3University of Queensland, Brisbane, QLD, Australia
Abstract
Background
Minimal change disease (MCD) is an important cause of nephrotic syndrome (NS). It is the leading pathology of NS in children, and accounts for only 10-15% of cases in the adult population. Like most glomerular diseases, it can be primary or secondary in aetiology. Common secondary aetiologies include medications, malignancy, immunisation and viral infection. Emerging research during the COVID-19 pandemic has demonstrated significant involvement of the kidney. The most common documented causes of COVID-19-related acute kidney injury include acute tubular necrosis and collapsing glomerulopathy. MCD has been described in numerous case reports as a phenomenon that occurs either de-novo or as a relapse following messenger ribonucleic acid (mRNA) vaccination for COVID-19. To our knowledge, however, it has only been described in nine other cases as an entity following or during acute COVID-19 infection.
Case Report
We describe a case of an 84-year-old male who presented to hospital with NS (serum albumin 14g/L, creatinine 469umol/L, urine protein-creatinine ratio 2000g/mol creatinine) three weeks after acute COVID-19 infection. This occurred on a background of normal kidney function, hypertension and ischaemic heart disease. He proceeded to have a kidney biopsy showing minimal change nephropathy. There were no other temporal triggers, such as mRNA vaccination or malgnancy. Our patient was treated with ciclosporin in addition to prednisolone. Unfortunately, he developed immunosuppression-related complications of opportunistic cytomegalovirus infection requiring antiviral therapy and steroid induced hyperglycemia requiring insulin. Six months from initial treatment, he remains in biochemical and clinical remission.
Conclusions
COVID-19 infection is a systemic illness with multi-organ involvement and long-term sequelae. It is important to consider glomerular diseases such as MCD as a result of acute illness with this virus.
Biography
Dr Sanjana Dang is a second year Kidney Advanced Trainee at the Princess Alexandra Hospital