Abstract：
We report a case of a 69-year-old Caucasian male with a history of hypertension, Type 2 diabetes, and Stage IIIa chronic kidney disease (CKD), who presented to the emergency department with positional dizziness, generalized weakness, weight loss, and suppressed appetite. Two months earlier, the patient was diagnosed with coronavirus disease 2019 (COVID-19). The patient had non-oliguric acute kidney injury alongside preexisting CKD. The urinalysis showed hematuria and significant non-nephrotic proteinuria. His serological markers were positive for antineutrophil cytoplasmic antibodies with high titers. A kidney biopsy showed focal crescentic glomerulonephritis of the pauci-immune type. Initially, treatment with immunosuppressive medication was deferred because the biopsy findings suggested a poor renal outcome, as the cortical sample showed tubular atrophy and interstitial fibrosis of more than 50%. The patient was discharged but was later readmitted with worsening renal function, deep venous thrombosis in the lower extremities, and patchy lung consolidation suggesting possible pneumonia, which was ruled out. He required dialysis and brief empiric antibiotics for pneumonia, and anticoagulation for deep venous thrombosis, and was treated with intravenous (IV) pulsed steroids, followed by gradually tapering oral steroids and rituximab induction therapy. He continued dialysis three times a week. Three months after discharge, his renal function improved to near-baseline level, and he no longer required hemodialysis. He continues to be on maintenance IV rituximab therapy and low-dose oral steroids and is followed closely by a rheumatologist. Our case reflects the evolving state of understanding how COVID-19 impacts the immune system, its varying manifestations, and its management.
摘要：
我们报告了一例69岁的高加索男性，有高血压病史，2型糖尿病,和IIIa期慢性肾病（CKD），他出现了位置性头晕，广义弱点，减肥,抑制食欲。两个月前,患者被诊断患有2019年冠状病毒病（COVID-19）。患者患有非少尿性急性肾损伤以及先前存在的CKD。尿液分析显示血尿和明显的非肾病性蛋白尿。他的血清学标记物对高滴度的抗中性粒细胞胞浆抗体呈阳性。肾脏活检显示免疫型局灶性新月体肾小球肾炎。最初，免疫抑制药物治疗被推迟，因为活检结果提示肾脏结局不佳，因为皮质样本显示肾小管萎缩和间质纤维化超过50%。患者出院，但后来因肾功能恶化而再次入院，下肢深静脉血栓形成,和斑片状的肺实变提示可能的肺炎，这被排除了。他需要透析和短暂的经验性抗生素治疗肺炎，和深静脉血栓形成的抗凝治疗，并接受静脉内（IV）脉冲类固醇治疗，随后逐渐减少口服类固醇和利妥昔单抗诱导治疗。他继续每周透析三次。出院三个月后,他的肾功能改善到接近基线水平,他也不再需要血液透析了.他继续进行维持IV利妥昔单抗治疗和低剂量口服类固醇，并由风湿病学家密切关注。我们的案例反映了人们对COVID-19如何影响免疫系统的理解的演变状态，其不同的表现形式，和它的管理。
