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SARS-CoV-2 Infection and It’s Association With Anti-Glomerular Basement Disease: A Case Series
Rakesh Sebastin, Arul Rajagopalan, Manorajan Rajendran, Jegan Arunachalam, Arun Prasath, Rakesh Durai
2021 ; 2021(1):
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Abstract Introduction:                      Anti-glomerular basement membrane (GBM) disease is a rare autoimmune disease leading to Rapidly Progressive Glomerulonephritis. There is a recent increase in the cases of Anti-GBM disease since the pandemic of novel SARS-CoV2 infection suggesting a possible association between the two. We report a case series of four patients affected with COVID-19 infection presenting later as Anti-GBM disease.   Methods:                     The study was done in Madurai Medical College during the period from September 2020 to March 2021. Four patients having Anti-GBM disease with either COVID RTPCR (swab test) or COVID IgG or IgM antibody positive were taken for the study. Their clinical features, Anti-GBM titre, renal parameters, renal biopsy pattern, progression to ESKD, response to treatment were studied.   Discussion:                      SARS- CoV2 infection by complement activation and inflammation causes pulmonary endothelial injury. This leads to the exposure of the alveolar basement membrane. This events may release the non-collagenase domain of the alfa 3 chain of type 4 collagen [a3(IV)NC1] found primary in the glomerular and alveolar basement membrane into circulation. The circulating NC1 auto antigen then stimulate auto reactive T and B cells resulting in anti-GBM disease. In our study all four patients have either Covid IgG or IgM positive and their anti-GBM titre elevated. One patient was positive for  P-ANCA. All four patients were treated with steroids, cyclophoshphomide, plasma exchange. Two patients recovered partially.  Two patients became dialysis dependent.     Conclusion:                        Our case series study supports the association of Anti-GBM disease and the novel SARS-CoV2 infection.
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