Characteristics and Outcomes of COVID-19 in Patients With Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

Kant, Sam; Raman, Gaurav; Damera, Pranav; Antiochos, Brendan; Seo, Philip; Geetha, Duvuru

doi:10.1016/j.ekir.2020.12.024

Cited by 11 publications

(11 citation statements)

References 7 publications

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“…All but one of the reported patients ( n = 18; 4 patients with a new diagnosis) of this case series survived. COVID-19 treatment was used at investigator's discretion, and included hydroxychloroquine ( n = 7), antibiotic measures such as azithromycin ( n = 4), and ritonavir/lopinavir ( n = 4) in earlier cases, while tocilizumab ( n = 2), convalescent plasma ( n = 2), remdesivir ( n = 4), and dexamethasone (2) were used in more recent cases [ 41 ]. Notably, most of these agents have been tested in large randomised controlled trials and proven to be ineffective in the meantime, and therefore, would not be used at the time of publication of this report any more.…”

Section: Covid-19 and Anca-associated Vasculitismentioning

confidence: 99%

The COVID-19 pandemic and ANCA-associated vasculitis – reports from the EUVAS meeting and EUVAS education forum

Kronbichler

Geetha

Smith

et al. 2021

Autoimmunity Reviews

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Section: Covid-19 and Anca-associated Vasculitismentioning

confidence: 99%

The COVID-19 pandemic and ANCA-associated vasculitis – reports from the EUVAS meeting and EUVAS education forum

Kronbichler

Geetha

Smith

et al. 2021

Autoimmunity Reviews

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“…The treatment remains the conventional treatment of AAV, based on corticosteroids associated with an immunosuppressant, either CYC or rituximab (RTX) [ 2 ]. This differentiates it from other types of post-infectious vasculitis which do not require an immunosuppressive treatment, and which often heal with treatment for the infection associated, with low corticosteroid therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Acute tubular injury (ATI) and collapsing glomerulopathy are the lesions most frequently described in this disease [ 1 ]. However, four cases of antineutrophilic autoantibody (ANCA)-associated vasculitis (AAV) in COVID-19 with pauci-immune glomerulonephritis have recently been described [ 2 ]. The occurrence of this form of kidney damage has several implications.…”

Section: Introductionmentioning

confidence: 99%

Recurrence or reactivation of SARS-CoV-2 infection after immunosuppressive therapy in patients with ANCA-associated vasculitis and COVID-19

Mbengue¹,

Bigirimana²,

Irankunda³

et al. 2022

CNCS

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. Acute tubular injury is the lesion most frequently described in this disease. However, four cases of ANCA-associated vasculitis (AAV) with COVID-19 with pauci-immune glomerulonephritis have recently been described. We report the case of an African woman, aged 70, in whom we diagnosed an AAV with pauci-immune glomerulonephritis in the context of COVID-19. She was treated with hydroxychloroquine and azithromycin for COVID-19. Corticosteroids and cyclophosphamide have been used for the treatment of vasculitis. The evolution was marked by the reappearance of COVID-19 one month after the beginning of an immunosuppressive therapy. The patient died a week later from respiratory failure. The occurrence of AAV during COVID-19 may not be due an unfortunate association but triggered by infection with SARS-CoV-2. The use of immunosuppressive therapy should be discussed due to the potential risk of reactivation or recurrence of the viral infection.

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“…It is hypothesized that this dysregulated immune response can trigger acute glomerular autoimmune disease or endothelial damage which can induce thrombotic microangiopathy (TMA). Indeed, there have been a few cases of ANCA-associated GN [ 59 , 60 ], IgA vasculitis [ 61 , 62 , 63 ], immune complex GN [ 64 ], and systemic lupus erythematosus [ 65 ] in patients with COVID-19. Of particular interest is the de novo nephrotic syndrome seen in some cases of COVID-19 infection [ 28 ].…”

Section: Can Covid-19 Infection Trigger De Novo Glomerular Disease?mentioning

confidence: 99%

Current Understanding of Clinical Manifestations of COVID-19 in Glomerular Disease

2021

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Background The novel coronavirus disease (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an evolving pandemic with significant mortality. Information about the impact of infection on glomerular disease patients in particular has been lacking. Understanding the virus's effect in glomerular disease is constantly changing. This review article summarizes the data published thus far on COVID-19 and its manifestations in pre-existing and de novo glomerular disease. Summary While patients with glomerular disease may be at higher risk of severe COVID-19 due to their immunosuppressed status, some data suggest that a low amount of immunosuppression may be helpful in mitigating the systemic inflammatory response which is associated with high mortality rates in COVID-19. There have been a few case reports on COVID-19 causing glomerular disease relapse in patients. Multiple mechanisms have been proposed for kidney injury, proteinuria, and hematuria in the setting of COVID-19. More commonly, these are caused by direct tubular injury due to hemodynamic instability and hypoxic injury. However, the cytokine storm induced by COVID-19 may trigger common post-viral glomerular disease such as IgA nephropathy, anti-GBM, and ANCA vasculitis that have also been described in COVID-19 patients. Collapsing glomerulopathy, a hallmark of HIV-associated nephropathy, is being reported SARS-CoV-2 cases, particularly in patients with high-risk APOL1 alleles. Direct viral invasion of glomerular structures is hypothesized to cause a podocytopathy due to virus's affinity to ACE2, but evidence for this remains under study. Key Messages Infection with SARS-CoV-2 may cause glomerular disease in certain patients. The mechanism of de novo glomerular disease in the setting of COVID-19 is under study. The management of patients with existing glomerular disease poses unique challenges, especially with regard to immunosuppression management. Further studies are needed to inform clinician decisions about the management of these patients during the COVID-19 pandemic.

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Characteristics and Outcomes of COVID-19 in Patients With Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

Cited by 11 publications

References 7 publications

The COVID-19 pandemic and ANCA-associated vasculitis – reports from the EUVAS meeting and EUVAS education forum

The COVID-19 pandemic and ANCA-associated vasculitis – reports from the EUVAS meeting and EUVAS education forum

Recurrence or reactivation of SARS-CoV-2 infection after immunosuppressive therapy in patients with ANCA-associated vasculitis and COVID-19

Current Understanding of Clinical Manifestations of COVID-19 in Glomerular Disease

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