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Collapsing Focal Segmental Glomerulosclerosis and Acute Oxalate Nephropathy in a Patient With COVID-19: A Double

Varun Malhotra1, Sandeep Magoon1, Dean A Troyer2

  • 1Eastern Virginia Medical School, Norfolk, VA, USA.

Journal of Investigative Medicine High Impact Case Reports
|October 6, 2020
PubMed

Insights

High-dose intravenous vitamin C for severe COVID-19 may trigger kidney injury, including collapsing FSGS and oxalate nephropathy, even in those with low-risk genetic variants. Careful risk-benefit assessment is crucial for COVID-19 treatments.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Genetics

Background:

  • COVID-19 (coronavirus disease 2019) management involves exploring various therapeutic interventions to mitigate severe disease progression and mortality.
  • High-dose intravenous vitamin C has been considered as a potential treatment for severe COVID-19.
  • Genetic factors, such as APOL-1 variants, are known to influence kidney disease susceptibility.

Observation:

  • A case study involving a patient with severe COVID-19 who received high-dose intravenous vitamin C.
  • The patient developed collapsing focal sclerosing glomerulosclerosis (FSGS) and acute oxalate nephropathy.
  • This occurred despite the patient having a low-risk heterozygous APOL-1 variant, a genotype typically associated with protection against kidney disease.

Findings:

  • The high-intensity COVID-19 cytokine storm potentially overwhelmed the protective effect of the heterozygous APOL-1 variant.
  • This suggests that severe systemic inflammation can exacerbate kidney injury independent of typical genetic risk factors.
  • The case highlights a potential adverse renal effect of high-dose intravenous vitamin C in the context of severe COVID-19.

Implications:

  • Therapeutic interventions for COVID-19 require individualized risk-benefit assessments due to the complexity of the disease and potential unknown interactions.
  • Renal biopsy should be strongly considered in patients with COVID-19 who present with multifactorial acute kidney injury.
  • Further research is needed to understand the precise mechanisms linking COVID-19, vitamin C therapy, and kidney pathology, especially in relation to genetic predispositions.

Keywords:
AKICOVIDFSGSSARScollapsingglomerulopathyoxalate

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