No abstract

COVID-19 primarily presents with respiratory involvement. Extrapulmonary manifestations as the sole manifestation also occur although rare. The kidney, being one of the organs with the greatest number of ACE receptors, is usually reported as part of multiorgan involvement. We report an early adolescent boy who presented with nephrotic–nephritic syndrome with severe kidney dysfunction from COVID-19 infection. He had low C3 and undetected antineutrophil cytoplasmic antibodies, antinuclear antibody and antistreptolysin O. Kidney biopsy revealed findings consistent with diffuse proliferative glomerulonephritis with a focal glomerular crescent formation and thin basement nephropathy. Due to the rapidly progressive deterioration of kidney function, he was given pulse methylprednisolone therapy followed by oral prednisone. Complete recovery was documented 12 weeks after the onset of post-infectious glomerulonephritis. The possible pathogenesis of glomerulonephritis in a patient with COVID-19, its differential diagnosis and treatment are discussed.

Introduction:Background: Approximately 50% of children with steroid sensitive nephrotic syndrome (SSNS) will suffer from frequent relapses or steroid dependent course which could be troublesome. In this pilot study, we compare the effectiveness and safety of oral cyclophosphamide and two doses of rituximab as first sparing medication in those children, Methods: This was a prospective open label randomized study of children with SSNS who relapsed frequently or showed a dependent course and received only prednisolone and levamisole. Children who received other immunosuppressive agents or those with a resistant course, evidence of impaired kidney function or leucopenia were excluded. The recruited children were allocated either to the cyclophosphamide or rituximab group. They were monitored for relapses and side effects for at least 12 months. Results: Forty-six subjects were included from two centers; 19 received rituximab and 27 received cyclophosphamide. The one-year relapse-free survival was better among patients treated with rituximab compared to those treated with cyclophosphamide (adjusted HR: 0.36; 95% CI: 0.09 -1.45); however, the difference was not statistically significant.Both rituximab and cyclophosphamide significantly reduced the lowest-dose of steroid required during the year before treatment, compared to the lowest-dose required during a year of follow-up after the start of treatmentsThe adverse-drug reactions (including leukopenia, acute hepatitis and cataract) were lower among patients treated with rituximab (5%) than among those treated with cyclophosphamide (22%); however, the difference was not statistically significant. Conclusions: Rituximab is effective and safe as first line sparing agent in children with steroid dependent or frequently relapsing nephrotic syndrome. A larger multicenter study is required to confirm its superiority over cyclophosphamide