De novo collapsing glomerulopathy in a pediatric kidney transplant recipient with COVID‐19 infection

The negative impact of COVID-19 on adults with underlying chronic kidney disease, including transplant recipients, has been well documented. Children have a less severe presentation and better prognosis compared to adults. However, little is known regarding the spectrum infection in children adolescents autoimmune disorders necessitating solid organ long-term immunosuppressive therapy. Case Report. An adolescent male developed end-stage disease secondary microscopic polyangiitis requiring living-donor transplant. Six years later, he antibody-mediated rejection his During treatment course, contracted SARS-CoV-2 new-onset nephrotic syndrome acute injury. Kidney biopsy revealed de novo collapsing focal segmental glomerulosclerosis background active antibody mediated rejection. Immunostaining for specimen demonstrated positive staining proximal tubular epithelium consistent intra-renal viral infection. Pulse corticosteroids, intravenous immunoglobulin, temporary reduction anti-metabolite therapy resulted successful recovery return graft function back pre-infection baseline. This case highlights clinical conundrum treating recipients midst pandemic. Pediatric can develop COVID-19-related complications. Judicious immunosuppression modulation necessary balance risk.