Covid-19 and adolescent acute kidney injury: Renal recovery with combined enalapril and estrogen therapy

Clin Chim Acta. 2022 Aug 18:S0009-8981(22)01264-5. doi: 10.1016/j.cca.2022.08.013. Online ahead of print.ABSTRACTCovid-19 in adolescence with multisystem inflammatory injury (MIS-C) is a newly described condition sharing key features with Kawasaki disease and toxic shock syndrome. A May 2020 United Nations WHO brief covering findings from North America and Europe drew notice to this acute post-viral illness characterized by severe, diffuse hyperinflammation leading to multiorgan failure. While females diagnosed with Covid-19 generally have more favorable outcomes than males, this protection is negated by a low estrogen state. This case reports on acute kidney injury/MIS-C with amenorrhea from ovarian insufficiency in childhood, itself an uncommon presentation of idiopathic hypogonadism. Three exon variants were previously identified in a healthy, phenotypically normal 46,XX adolescent who subsequently underwent whole genome sequencing (WGS). She had only two spontaneous menses with a provisional diagnosis of premature ovarian insufficiency made by age 15. Against this background, Covid-19 infection necessitated hospital admission where progressively reduced renal function was a prime component of MIS-C. Combined angiotensin-converting enzyme inhibitor plus transdermal estrogen replacement therapy resulted in normalized estimated glomerular filtration rate (eGFR) from baseline 43 to 68ml/min/1.73m2, post-treatment. Serum cystatin-C also improved during this interval from 1.69 ...
Source: International Journal of Clinical Chemistry - Category: Chemistry Authors: Source Type: research