Title: COVID 19: Trigger for crescentric IgA nephropathy or innocent bystander

Biography:

Bhanu Mishra has his expertise in evaluation and passion in improving the health and wellbeing. Dedication to the field of nephrology and special focus on dialysis patients are his virtues. Public health awareness and focusing on renal health also are of great interest to him.

Abstract

Episodic macroscopic hematuria is the hallmark clinical feature of IgA nephropathy. Visible hematuria is often synpharyngitic meaning it occurs concurrently with an infection often of the upper respiratory tract. COVID 19 is well documented now to be associated with acute kidney injury and also with glomerulonephritis particularly collapsing FSGS. We here describe a case of a young male who developed gross hematuria and fever. He had no flank pain, weight loss or palpable abdominal swelling. Workup was suggestive of COVID19 positivity and hematuria was glomerular on microscopic examination. During workup he developed facial puffiness and leg swelling and noticed decreased urine output. His creatinine shot upto to 2.5mg/dl from a baseline of 0.8 mg/dl 15 days back. USG showed normal sized kidneys, normal cortico-medullary differentiation with no obstruction. Serological workup was negative for hypocomplementemia, ANA, ANCA(pr3 and mpo), anti GBM antibodies. Biopsy done was suggestive of crescentric IgA nephropathy, HAAS class4 and OXFORD MEST- M0E0S0T0 C2. He had history of NSAID intake and severe myalgias but workup was negative to substantiate contribution of these etiologies. There was recent case series from UK suggesting possible role of COVID19 and increased prevalence of anti-GBM disease. We here propose possible role of COVID 19 in triggering the IgA crescentric glomerulonephritis.