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The term COVAN (COVID-19-associated nephropathy) has been used to describe collapsing focal segmental glomerulosclerosis (FSGS) in individuals who have been infected with the SARS-CoV-2. This helps differentiate it from the majority of cases of acute kidney injury in COVID-19 patients, which are typically caused by acute tubular injury. The exact pathophysiology is unclear but is proposed to involve pro-inflammatory cytokines such as type 1 interferons, which are thought to increase expression of the APOL1 gene in glomerular epithelial cells. This triggers a cascade of inflammatory events that cause damage to the epithelia and underlying podocytes. The treatment of COVAN is centered on general supportive measures including dietary sodium restriction, optimization of hyperlipidemia and hypertension, RAAS blockade, and diuresis for edema. There is limited data to support the use of glucocorticoids in COVAN; however, the mechanism of podocytopathy is similar to that in HIVAN (HIV-associated nephropathy), with high disease burden in those with APOL1 gene mutation. Based on previous experience, treatment of HIVAN with glucocorticoids is beneficial and safe in selected patients. Here we present a case of COVAN which was successfully treated with glucocorticoids, and at 22-month follow-up patient remained in full remission (proteinuria < 1,000 mg/g) with stable kidney function.

and its associated lung physiology, most notably its role in acute respiratory distress syndrome (ARDS), is an evolving medical illness. Clinical management is still being studied, however, it is well documented that pronated patients with non-COVID ARDS can improve oxygenation and V/Q mismatch, as well as increase lung volume and recruitment of collapsed alveoli. We hypothesized that proning patients with COVID-19 pneumonia will have similar pathophysiologic advantages and lead to less need for mechanical ventilation, lower mortality, and shorter hospitalization time. Methods: We conducted a large retrospective, single-institution cohort analysis of adult patients with diagnosed SARS-CoV-19 pneumonia who were admitted to our medical intensive care unit (ICU) between 3/11/2020 and 8/19/2020. We categorized patients into proning (at least 4 hours daily) versus non-proning cohorts. The primary outcome of our study was progression to mechanical ventilation while secondary outcomes compared in-hospital mortality rates, ICU and hospital length of stay (HLOS). We used the quick-COVID Severity Index (qCSI) to assign baseline severity scores to all patients. Results: A total of 270 patients with severe COVID-19 pneumonia were admitted to the ICU. Nine patients were excluded due to unrelated illness confounders, leaving a total of 261 patients (including 9 patients who were intubated before their first proning session). Of the patients who proned for 4 or more hours daily, 38.99% (23/59) required mechanical ventilation after proning compared with 41.97% (81/193) who were not proned (pvalue = .68). Secondary outcomes for those proned vs not proned include; in-hospital mortality of 22.06% (15/68) vs 33.12% (62/193) a p-value of .12, median HLOS 14 days vs 13 days, ICU LOS 6 days vs 4 days. The qCSI score for the proned group was 6.77 vs 6.68 for those not proned. Conclusions: Based on our analysis, there was not a statistically significant reduction in the progression to MV in patients with severe SARS-CoV-19 pneumonia who proned compared to those who did not prone. However, there was a positive correlation associated with proning and reduction in the in-hospital mortality rate of these patients, a difference of 11%. Additionally, there was no significant difference in ICU LOS or HLOS.