ESPN 53rd Annual Meeting

ESPN 2021


 
Renal involvement and histological findings in two pediatric COVID-19 patients
ANTONIO MASTRANGELO 1 JESSICA SERAFINELLI 1 WILLIAM MORELLO 1 VALERIA FANNY CERIONI 2 GIOVANNI MONTINI 1

1- FONDAZIONE IRCCS CA GRANDA OSPEDALE MAGGIORE POLICLINICO MILANO
2- ASST MONZA E BRIANZA
 
Introduction:

Kidney involvement and histological findings have been rarely reported in pediatric SARS-CoV-2 infection. Acute tubular necrosis is the most common histological finding in adults, but the exact mechanism of kidney involvement is unclear.

Material and methods:

We describe clinical, laboratory and histological findings of two pediatric cases with an almost exclusive renal involvement by SARS-CoV2 without pre-existing diseases.

Results:

A 10-years-old girl with IgA vasculitis nephritis underwent a renal biopsy, showing a diffuse and segmental mesangial-proliferative glomerulonephritis. A steroid therapy was started (methylprednisolone, prednisone). After few weeks, clinical conditions worsened (weight gain, nephritic-nephrotic syndrome) and an atypical skin rash appeared. A SARS-CoV-2 infection was diagnosed. An electron microscopy evaluation revealed cytoplasmatic blebs and virus-like particles in tubular cells. After few days, SARS-CoV-2 infections was cleared and cyclophosphamide was added to prednisone for 10 weeks. A second kidney biopsy was performed showing a crescentic glomerulonephritis with jalinosis, while virus-like particles were no more present. 

The second patient was a 12-year-old girl with a 3-week history of progressive weakness and weight loss. A mild rhinitis was reported the month before. No medications were taken. Blood and urine analysis revealed rise in serum creatinine (1.8 mg/dL), hypouricemia (1.8 mg/dl), severe low molecular weight proteinuria, low urinary gravity (1008), glycosuria, and proteinuria (uPCR 0.5 mg/mg). Patient showed a high SARS-CoV-2-IgG titre (195 AU/ml). A kidney biopsy was performed, showing features of acute tubular-interstitial nephritis. On EM, no images suggestive for virus-like particles were observed. Steroid therapy was started and resulted effective to restore a normal renal function. 

In both cases RT-PCR was negative for SARS-CoV-2 on renal tissue.

Conclusions:

Kidney involvement is uncommon in children and related histological data are lacking, being reported only in two children with SARS-CoV-2-associated AKI. The diagnosis was acute necrotizing glomerulonephritis in both cases.  RT-PCR for SARS-CoV-2 tested negative while EM was not performed. We firstly completely describe renal histological and clinical finding in SARS-CoV-2 positive children. We can speculate that in both cases SARS-CoV-2 played a major role as inflammatory trigger of the renal damage. We suggest investigating the potential kidney damage by SARS-CoV-2 in children and that SARS-CoV2 can be included among infectious agents of pediatric acute tubular interstitial nephritis.