Minimal Change Disease With Nephrotic Syndrome Associated With Coronavirus Disease 2019 After Apolipoprotein L1 Risk Variant Kidney Transplant: A Case Report.

Masaaki Yamada, Prerna Rastogi, Dilek Ince, Abdullah Thayyil, M Adela Mansilla, Richard J H Smith, Sarat Kuppachi, Christie P Thomas

Transplantation proceedings 2020 Nov

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Kidney injury is a well-known complication in people with coronavirus disease 2019 (COVID-19). In kidney transplant recipients with COVID-19, presentation with nephrotic syndrome has not been well described. We report on a 49-year-old black female kidney transplant recipient who presented 25 years after transplant with clinical features of nephrotic syndrome following a diagnosis of COVID-19. Histologic examination showed acute tubular injury with unremarkable glomeruli on light microscopy and diffuse foot process effacement of podocytes on electron microscopy, consistent with minimal change-like podocyte injury. Apolipoprotein L1 (APOL1) genetic testing confirmed 2 high-risk APOL1 alleles in the kidney donor. We speculate that COVID-19-induced systemic or local cytokine release could serve as a second hit in the presence of APOL1 risk alleles and mediate a podocytopathy manifesting as nephrotic syndrome. The presented case with minimal change-like disease, occurring in the context of the donor high-risk APOL1 genotype, extends the spectrum of clinical manifestations in COVID-19-associated nephropathy. Copyright © 2020 Elsevier Inc. All rights reserved.

Citation

Masaaki Yamada, Prerna Rastogi, Dilek Ince, Abdullah Thayyil, M Adela Mansilla, Richard J H Smith, Sarat Kuppachi, Christie P Thomas. Minimal Change Disease With Nephrotic Syndrome Associated With Coronavirus Disease 2019 After Apolipoprotein L1 Risk Variant Kidney Transplant: A Case Report. Transplantation proceedings. 2020 Nov;52(9):2693-2697