Nephritic syndrome in post-COVID-19 infection. A case report

Abstract

Introduction. The SARS-Cov-2 virus has gradually become a major health concern affecting numerous human organs. Although SARS- Cov-19 affects mostly the respiratory system, another important target is the function of the kidney, which can manifest with nephritic syndrome especially in patients with comorbidities such as rheumatic diseases. Case presentation. We selected a 71-year-old woman with a clinical history of rheumatoid arthritis with the goal to present a case of onset nephritic syndrome after suffering from SARS-Cov-2 infection. The patient was diagnosed with rheumatoid arthritis in 2007 and was treated with methotrexate from 2008 to 2012. In 2009 she received treatment with tocilizumab intravenous 8 mg per kg once a month for 6 months. Leflunomide 10 mg per day periodically with metipred 4-8 mg per day during the exacerbation. In 2019 the patient was diagnosed with septic arthritis of the left knee joint and leflunomide 10 mg per day without corticosteroids was administered. The first time she was diagnosed with SARS-Cov-2 infection in October 2021, had oligo-anuria for 3 days, but the diuresis has normalized after she took drugs with diuretic effects and phytotherapy. In february 2022 she was diagnosed the second time with SARS-Cov-2 infection. On 20th of february she described periorbital edema with oliguria and excretion of brown urine. Oliguria was present every day during the period of 40 days. Blood biochemical analysis indicates creatinine levels 148.12 µmol/L. On 1st of march in her urine analysis have been detected next alterations: erythrocyte count >100, leukocyte count 20-25, flat epithelium 5-6, positive for nitrite, presence of mucus and bacteria. Discussion. The clinical manifestations such as periorbital edema, brown color of urine and the results of the para-clinical investigations with oliguria, macrohematuria, increased levels of serum creatinine demonstrates the presence of the nephrotic syndrome post-SARS-CoV-2 in a 71-year-old woman with a clinical history of rheumatoid arthritis. Based on these evidences we can suspect IgA nephropathy, also known as Berger's disease. Conclusion. While some studies demonstrate that the incidence of post-SARS-Cov-2 nephritic syndrome is low, the subject still remains insufficiently studied. It is important to take into consideration that patients who suffered SARS-Cov-2 can present with nephritic syndrome for improvement in the management of SARS-CoV-2 patients.