Chronic kidney disease linked to SARS-CoV-2 infection: a case report
Abstract Background The recent COVID-19 pandemic has raised concerns about patient diagnosis and follow-up of chronically ill patients. Patients suffering from chronic illnesses, concomitantly infected by SARS-CoV-2, globally tend to have a worse prognosis and poor outcomes. Renal tropism and acute...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-08-01
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| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12882-021-02490-z |
| _version_ | 1818596593844092928 |
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| author | Georges Tarris Alexis de Rougemont Marie-Anaïs Estienney Julien Journet Anne-Cécile Lariotte Damien Aubignat Jean-Michel Rebibou Mathilde Funes De La Vega Mathieu Legendre Gael Belliot Laurent Martin |
| author_facet | Georges Tarris Alexis de Rougemont Marie-Anaïs Estienney Julien Journet Anne-Cécile Lariotte Damien Aubignat Jean-Michel Rebibou Mathilde Funes De La Vega Mathieu Legendre Gael Belliot Laurent Martin |
| author_sort | Georges Tarris |
| collection | DOAJ |
| description | Abstract Background The recent COVID-19 pandemic has raised concerns about patient diagnosis and follow-up of chronically ill patients. Patients suffering from chronic illnesses, concomitantly infected by SARS-CoV-2, globally tend to have a worse prognosis and poor outcomes. Renal tropism and acute kidney injury following SARS-CoV-2 infection has recently been described in the literature, with elevated mortality rates. Furthermore, patients with pre-existing chronic kidney disease, infected by SARS-CoV-2, should be monitored carefully. Here, we report the case of a 69-year-old patient with splenic marginal zone lymphoma, suffering from longstanding chronic kidney disease following SARS-CoV-2 infection. Case presentation A 69-year-old male patient previously diagnosed with pulmonary embolism and splenic marginal zone lymphoma (Splenomegaly, Matutes 2/5, CD5 negative and CD23 positive), was admitted to the hospital with shortness of breath, fever and asthenia. A nasopharyngeal swab test was performed in addition to a CT-scan, which confirmed SARS-CoV-2 infection. Blood creatinine increased following SARS-CoV-2 infection at 130 μmol/l, with usual values at 95 μmol/l. The patient was discharged at home with rest and symptomatic medical treatment (paracetamol and hydration), then readmitted to the hospital in August 2020. A kidney biopsy was therefore conducted as blood creatinine levels were abnormally elevated. Immunodetection performed in a renal biopsy specimen confirmed co-localization of SARS-CoV2 nucleocapsid and protease 3C proteins with ACE2, Lewis x and sialyl-Lewis x antigens in proximal convoluted tubules and podocytes. Co-localization of structural and non-structural viral proteins clearly demonstrated viral replication in proximal convoluted tubules in this chronically ill patient. Additionally, we observed the co-localization of sialyl-Lewis x and ACE2 receptors in the same proximal convoluted tubules. Reverse Transcriptase-Polymerase Chain Reaction test performed on the kidney biopsy was negative, with very low Ct levels (above 40). The patient was finally readmitted to the haematology department for initiation of chemotherapy, including CHOP protocol and Rituximab. Conclusions Our case emphasizes on the importance of monitoring kidney function in immunosuppressed patients and patients suffering from cancer following SARS-CoV-2 infection, through histological screening. Further studies will be required to decipher the mechanisms underlying chronic kidney disease and the putative role of sialyl-Lewis x and HBGA during SARS-CoV-2 infection. |
| first_indexed | 2024-12-16T11:34:23Z |
| format | Article |
| id | doaj.art-1a064feb61db4c65adbc2bfb0cbd2c12 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-16T11:34:23Z |
| publishDate | 2021-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-1a064feb61db4c65adbc2bfb0cbd2c122022-12-21T22:33:09ZengBMCBMC Nephrology1471-23692021-08-012211610.1186/s12882-021-02490-zChronic kidney disease linked to SARS-CoV-2 infection: a case reportGeorges Tarris0Alexis de Rougemont1Marie-Anaïs Estienney2Julien Journet3Anne-Cécile Lariotte4Damien Aubignat5Jean-Michel Rebibou6Mathilde Funes De La Vega7Mathieu Legendre8Gael Belliot9Laurent Martin10Department of Pathology, University Hospital of DijonNational Reference Centre for Gastroenteritis Viruses, Laboratory of Virology, University Hospital of DijonNational Reference Centre for Gastroenteritis Viruses, Laboratory of Virology, University Hospital of DijonDepartment of Nephrology, William Morey HospitalDepartment of Pathology, University Hospital of DijonDepartment of Pathology, University Hospital of DijonDepartment of Nephrology, University Hospital of DijonDepartment of Pathology, University Hospital of DijonDepartment of Nephrology, University Hospital of DijonNational Reference Centre for Gastroenteritis Viruses, Laboratory of Virology, University Hospital of DijonDepartment of Pathology, University Hospital of DijonAbstract Background The recent COVID-19 pandemic has raised concerns about patient diagnosis and follow-up of chronically ill patients. Patients suffering from chronic illnesses, concomitantly infected by SARS-CoV-2, globally tend to have a worse prognosis and poor outcomes. Renal tropism and acute kidney injury following SARS-CoV-2 infection has recently been described in the literature, with elevated mortality rates. Furthermore, patients with pre-existing chronic kidney disease, infected by SARS-CoV-2, should be monitored carefully. Here, we report the case of a 69-year-old patient with splenic marginal zone lymphoma, suffering from longstanding chronic kidney disease following SARS-CoV-2 infection. Case presentation A 69-year-old male patient previously diagnosed with pulmonary embolism and splenic marginal zone lymphoma (Splenomegaly, Matutes 2/5, CD5 negative and CD23 positive), was admitted to the hospital with shortness of breath, fever and asthenia. A nasopharyngeal swab test was performed in addition to a CT-scan, which confirmed SARS-CoV-2 infection. Blood creatinine increased following SARS-CoV-2 infection at 130 μmol/l, with usual values at 95 μmol/l. The patient was discharged at home with rest and symptomatic medical treatment (paracetamol and hydration), then readmitted to the hospital in August 2020. A kidney biopsy was therefore conducted as blood creatinine levels were abnormally elevated. Immunodetection performed in a renal biopsy specimen confirmed co-localization of SARS-CoV2 nucleocapsid and protease 3C proteins with ACE2, Lewis x and sialyl-Lewis x antigens in proximal convoluted tubules and podocytes. Co-localization of structural and non-structural viral proteins clearly demonstrated viral replication in proximal convoluted tubules in this chronically ill patient. Additionally, we observed the co-localization of sialyl-Lewis x and ACE2 receptors in the same proximal convoluted tubules. Reverse Transcriptase-Polymerase Chain Reaction test performed on the kidney biopsy was negative, with very low Ct levels (above 40). The patient was finally readmitted to the haematology department for initiation of chemotherapy, including CHOP protocol and Rituximab. Conclusions Our case emphasizes on the importance of monitoring kidney function in immunosuppressed patients and patients suffering from cancer following SARS-CoV-2 infection, through histological screening. Further studies will be required to decipher the mechanisms underlying chronic kidney disease and the putative role of sialyl-Lewis x and HBGA during SARS-CoV-2 infection.https://doi.org/10.1186/s12882-021-02490-zCoronavirusCOVID-19SARS-CoV-2Chronic viral replicationChronic kidney diseaseImmunocompromised |
| spellingShingle | Georges Tarris Alexis de Rougemont Marie-Anaïs Estienney Julien Journet Anne-Cécile Lariotte Damien Aubignat Jean-Michel Rebibou Mathilde Funes De La Vega Mathieu Legendre Gael Belliot Laurent Martin Chronic kidney disease linked to SARS-CoV-2 infection: a case report BMC Nephrology Coronavirus COVID-19 SARS-CoV-2 Chronic viral replication Chronic kidney disease Immunocompromised |
| title | Chronic kidney disease linked to SARS-CoV-2 infection: a case report |
| title_full | Chronic kidney disease linked to SARS-CoV-2 infection: a case report |
| title_fullStr | Chronic kidney disease linked to SARS-CoV-2 infection: a case report |
| title_full_unstemmed | Chronic kidney disease linked to SARS-CoV-2 infection: a case report |
| title_short | Chronic kidney disease linked to SARS-CoV-2 infection: a case report |
| title_sort | chronic kidney disease linked to sars cov 2 infection a case report |
| topic | Coronavirus COVID-19 SARS-CoV-2 Chronic viral replication Chronic kidney disease Immunocompromised |
| url | https://doi.org/10.1186/s12882-021-02490-z |
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