Relapsing Nephrotic Syndrome Associated with COVID-19

Jusli Aras, Andi Utari Dwi Rahayu, Husein Albar


An 8-year and 2 month-old girl presented with generalized oedema for 2 days with mild cough and shortness of breath. She was diagnosed as relapsing nephrotic syndrome (NS) and Community Acquired Pneumonia due to COVID-19 infection. The patient was discharged with complete remission NS and repeated negative PCR for SARS-CoV-2 from nasopharyngeal swabs. It is important to consider COVID-19 infection as a likely trigger to relapsing NS in children.

Seorang anak perempuan umur 8 tahun 2 bulan masuk rumah sakit karena edema anasarca selama 2 hari disertai batuk ringan dan sulit bernapas. Diagnosis adalah sindrom nefrotik relaps, pneumonia COVID-19, dan malnutrisi. Pasien dipulangkan setelah sindrom nefrotik remisi dan hasil PCR SARS-CoV-2 negatif. Infeksi COVID-19 penting dipertimbangkan sebagai pencetus relaps sindrom nefrotik.

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Nephrotic syndrome in children: prediction of histopathology from clinical and laboratory characteristics at time of diagnosis. A report of the International Study of Kidney Disease in Children. Kidney Internat 1978, 13(2):159–65.

McKinney PA, Feltbower RG, Brocklebank JT, Fitzpatrick MM. Time trends and ethnic patterns of childhood nephrotic syndrome in Yorkshire, UK. Pediatr Nephrol. 2001;16(12):. 1040–4.

Niaudet P. Steroid-sensitive idiopathic nephrotic syndrome in children. Di dalam: Ellis D, William EH, Patrick N (eds). Paediatric Nephrology. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2004; 543 – 56.

Noer MS. Sindrom Nefrotik Idiopatik. In: Noer MS et al, ed. Kompendium Nefrologi Anak. Jakarta: UKK Nefrologi IDAI 2011. p 72-87.

Tarshish P, Tobin JN, Bernstein J, Edelman CM. Prognostic significance of the early course of minimal change nephrotic syndrome: report of the international study of kidney disease in children. J Am Soc Nephrol 1997; 8: 769 –76.

Niaudet P, Boyer O. Idiopathic nephrotic syndrome in children: clinical aspects.In: Avner ED, Harmon WE, Niaudet P, Yoshikawa N, eds. Pediatric Nephrology vol.,1. 6th ed. Springer; 2009. p.667-702.

Gipson DS, Massengill SF, Yao L, Nagraj S, Smoyer WE, Mahan JD, et al. Management of childhood onset nephrotic syndrome. Pediatrics 2009; 124: 747-57.

Gulati S, Kher V, Gupta A, Arora P, Rai PK, Sharman RK. Spectrum of infections in nephrotic syndrome. Pediatr Nephrol 1995; 9; 431-4.

Moorani KN, Khan KM, Ramzan A. Infections in children with nephrotic syndrome. J Coll Physicians Surg Pak 2003; 13: 337-9.

Iqbal SMJ, Azhar IA, Ahmed TM, Sarfaraz M. The incidence and types of infections in children with nephrotic syndrome. Ann KE Med Coll 2002; 8: 105- 7.

Lu X, Zhang L, Du H et al. Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 infection in children. N Engl J Med. 2020.

Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020;10.1001/jama.2020.2648.

WHO. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) [Internet]. 2020. china-joint-mission-on-COVID-19-final-report.pdf.

Livingston E, Bucher K. Coronavirus disease 2019 (COVID- 19) in Italy. JAMA. 2020.

Coronavirus Disease 2019 in Children - United States, February 12–April 2, 2020.CDC COVID-19 Response Team (2020). MMWR Morb Mortal Wkly Rep. 10;69 (14):422–6.

Red Nacional de Vigilancia Epidemiológica. Situación de COVID- 19 en España. Informe 22 [Internet]. 2020.

Centers for Disease Control and Prevention. If You Are Immunocompromised, Protect Yourself From COVID-19. Coronavirus Disease 2019 (COVID-19). 2020.

Ulinski T, Aoun B. Pediatric idiopathic nephrotic syndrome: treatment strategies in steroid dependent and steroid resistant forms. Curr Med Chem 2010;17:847-53.

Moorani KN. Infections are common a cause of relapse in children with nephrotic syndrome. Pak Paed J. 2011;35:213–9.

MacDonald N, Wolfish N, Mclaine P, Phipps P, Rossier E. Role of respiratory viruses in exacerbations of primary nephrotic syndrome. J Paediatr. 1986;108:378–82.

Takahashi S, Wada N, Murakami H, Funaki S, Inagaki T, Harada K, et al. Triggers of relapse in steroid-dependent and frequently relapsing nephrotic syndrome. Pediatr Nephrol. 2007;22:232–6.

Uwaezuoke SN. Steroid‐sensitive nephrotic syndrome in children: Triggers of relapse and evolving hypotheses on pathogenesis. Ital J Pediatr 2015;41:19.

Coronavirus Disease 2019 (COVID-19) - If You Are Immunocompromised, Protect Yourself From COVID-19. National Institutes of Health. Available at https://www. covid19 treatment Accessed May 30th, 2020.

Jiang Y, Xu BP, Jin RM, et al. Expert consensus on diagnosis, treatment and prevention of novel coronavirus infection in pediatrics (first edition) [Standard Programme Guideline]. Chin J Appl Clin Pediatr. 2020;35(2): 81‐85

Fang F, Luo XP. Facing 2019 novel coronavirus infections: a pediatrician's thinking. Clin J Pediatr. 2020;58(2):81‐85.‐1310.2020.02.001

Kanne JP.. Chest CT Findings in 2019 Novel Coronavirus (2019-nCoV) Infections from Wuhan, China: Key Points for the Radiologist. Radiology 2020. 295(1): 16-17.

Ai Tao et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020. doi: 10.1148/radiol.2020200642

Tahamtan A, Ardebili A. Real-time RT-PCR in COVID-19 detection: issues affecting the results. Expert Rev Mol Diagn. 2020;20(5):453-454. doi: 10.1080 /14737159 .2020 .1757437

WHO. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). 2020; who-china-joint-mission-on-COVID-19-final-report.pdf.

Bi Q, Wu Y, Mei S, Ye C, Zou X, Zhang Z, et al. Epidemiology and Transmission of COVID-19 in Shenzhen China: Analysis of 391 cases and 1,286 of their close contacts. medRxiv. 2020. 03.20028423.

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at https://www.covid19 Accessed May 30th, 2020.

Melgosa M, Madrid A, Alvárez O, Lumbreras J, Nieto F, Parada E, Perez-Beltrán V,. SARS-CoV-2 infection in Spanish children with chronic kidney pathologies. Pediatr. Nephrol. 2020;35:1521–4


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