Abstract

Background: Coronaviruses (CoVs) are members of the Nidovirales family, Coronaviridae. To date, seven human CoVs have been identified, some of which are known to circulate persistently in the human population, particularly among young infants. Among these CoV types, renal disease is a recognized complication associated with SARS-CoV-2. No cases of renal disease caused by HCoVNL63 have been reported.

Case report: A 4-year-old girl presented with severe renal injury and cardiorespiratory collapse as a result of HCoV-NL63-associated glomerulonephritis. Histopathology from a renal biopsy revealed severe tubulointerstitial changes. She was subsequently placed on continuous ambulatory peritoneal dialysis (CAPD) with a Tenckhoff catheter as a long-term renal replacement therapy due to her incomplete recovery.

Conclusion: HCoV-NL63, previously identified as causing moderate respiratory symptoms in infants, is capable of inducing severe renal impairment in childhood. Histopathological findings in the renal area are critical in determining the pathology of this rare etiology that causes childhood glomerulonephritis. This report emphasizes the novelty and importance of this rare case in pediatric nephrology.

Introduction

Coronaviruses (CoVs) are members of the Nidovirales family, within the Coronaviridae subfamily. CoVs are positive-strand RNA viruses with large genomes ranging in size from 27 to 33 kb1. To date, seven human CoVs have been identified, some of which persistently circulate in the human population, particularly among young infants. Initially detected in the mid-1960s, HCoV-229E and HCoV-OC43 have been associated with the common cold and, in rare cases, with lower respiratory tract infections2. In 2003, a third human coronavirus (SARS-CoV) was identified as the causative agent of severe acute respiratory syndrome (SARS)1. HCoV-NL63 and HCoV-HKU1 were two additional human coronaviruses identified after 20031. The Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in the Arabian Peninsula in 2012 as a highly lethal human pathogen2. The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), was discovered in Wuhan, China, in 2019 and has since caused a global pandemic3. Among these CoV types, renal disease has been recognized as a complication associated with SARS-CoV-2, as previously reported by Lv W et al.2. Specific studies directly correlating HCoV-NL63 with renal impairment in pediatric patients are limited. While some children with HCoV-NL63 infections have underlying health issues, including renal problems, the majority of research focuses on respiratory outcomes, and the direct causative relationship remains to be established. We present the case of a 4-year-old girl who presented with severe renal injury and cardiorespiratory collapse as a result of HCoV-NL63-associated glomerulonephritis. We have reviewed the associated pathology of the underlying disease.

Methods

A 4-year-old girl presented with a sudden onset of cardiorespiratory collapse following a 2-day history of cough, coryza, loose stools, and vomiting. The patient exhibited severe acute renal injury (ARI) and hepatorenal syndrome, complicating her condition. She was ventilated due to respiratory failure and hemodynamic instability. She had anuric renal failure and received continuous veno-venous hemofiltration (CVVH) via a right internal jugular vein catheter for five days.rd percentile). She appeared sallow and was not edematous. She was afebrile and hypertensive, with a pulse rate of 100 beats per minute and a blood pressure of 160/100 mmHg. Her skin was dry, with scabs from a previous skin infection covering her body. Lung auscultation revealed diminished breath sounds bilaterally. The remaining systemic examinations were inconclusive.

Table 1.

Laboratory investigations

27/5/23 10/6/23 13/6/23 15/6/23 23/6/23 WBC ꝉ (10 9 /L) 16.4 30.28 15.5 10.28 20.8 Haemoglobin (g/dL) 5.4 12.8 9.9 9.7 9.1 Haematocrit 15.9 38.2 30.9 30.7 27.7 Platelet (10 9 /L) 250 1097 929 847 728 Sodium 137 140 142 142 138 Potassium 5.2 2.9 3.5 4.9 4.7 Urea 45.9 23 24.4 23 17.3 Creatinine 1467 800 715 496 446 Calcium 1.85 2.45 2.32 2.38 2.17 Phosphate 5.43 1.56 2.19 1.54 1.88 ALP ‡ 110