J Korean Med Sci.  2023 Mar;38(12):e89. 10.3346/jkms.2023.38.e89.

De Novo Crescentic Glomerulonephritis Following COVID-19 Infection: A Pediatric Case Report

• Eun JK
• Park MJ
• Kim Ms
• Han MH
• Kim YJ
• Baek HS
• Cho MH

• KMID: 2541037
• DOI: http://doi.org/10.3346/jkms.2023.38.e89

Abstract

As the global coronavirus disease 2019 (COVID-19) pandemic continues to sweep across the globe, reports of kidney involvement in adult patients infected with COVID-19 have been documented, and recently, cases in the pediatric population have also been reported. This report highlights the case of an 11-year-old boy who developed acute kidney injury presenting as gross hematuria, proteinuria, and hypertension immediately after a COVID-19 infection. A renal biopsy allowed us to diagnose the patient with post-COVID-19 infectionassociated de novo crescentic immune-mediated glomerulonephritis. Oral prednisolone and cyclophosphamide treatments were initiated after methylprednisolone pulse therapy administration. Currently, the patient is receiving medical treatment for five weeks, and his renal function is gradually recovering. Previous studies have suggested that, although quite rare, a variety of kidney complications can occur after COVID-19 infection or vaccination, and it is recommended to monitor renal function through evaluation. Herein, we report a pediatric case of post-COVID-19 infection-associated de novo crescentic immune-mediated glomerulonephritis consistent with rapidly progressive glomerulonephritis.

Keyword

De Novo; Crescentic Glomerulonephritis; COVID-19; Pediatric

Figure

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  Fig. 1 Trend of laboratory test results of the patient during hospitalization.eGFR = estimated glomerular filtration rate, PCR = protein creatinine ratio, i.v. = intravenous.

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  Fig. 2 Renal pathologic findings of the patient. (A) Endocapillary proliferation with some neutrophils and karyorrhexis (circle: karyorrhexis), fibrinoid necrosis and cellular crescent (arrow: fibrinoid necrosis) (H&E ×400). (B) Endocapillary proliferation with cellular crescents (PAM ×400). (C) Many leukocytes in the capillary lumens (endocapillary proliferation) and extensive foot process effacement with microvillous transformation. (D) Many subendothelial and mesangial electron dense deposits and intraluminal leukocyte. (E, F) Immunofluorescence revealed diffuse mesangial C3 (E) and IgA (F) deposit (×400).H&E = hematoxylin and eosin, PAM = periodic acid methenamine silver.

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