Double glomerulopathies or two-faced janus? A challenging case in the COVID-19 era

SARS-CoV-2 very often causes kidney involvement through various mechanisms including: acute tubular injury, virus cell invasion, vascular damage due to hypercoagulability and finally dysregulation of the immune system. Even though there are no pathognomonic morphologic features that can rule out or confirm direct damage by SARS-CoV-2, the latest literature suggests that there may be some association. SARS-CoV-2 infection represents a poor prognostic factor, regardless of pulmonary involvement. We report a challenging case with complex renal biopsy findings suggestive of collapsing glomerulopathy and focal proliferative IgA-dominant glomerulonephritis in a patient affected by active hepatitis C virus (HCV), SARS-CoV-2 infection and personal history of cocaine abuse.

Automated summary

SARS-CoV-2 infection often leads to kidney damage through various mechanisms. Although there is no definitive evidence of direct damage by the virus, recent literature suggests a possible association. Regardless of pulmonary involvement, SARS-CoV-2 infection is a poor prognostic factor. We present a challenging case of collapsing glomerulopathy and focal proliferative IgA-dominant glomerulonephritis in a patient with active hepatitis C virus (HCV), SARS-CoV-2 infection, and a history of cocaine abuse.