Child with new onset nephrotic syndrome as the sole manifestation of SARS‐CoV‐2 infection

As the COVID-19 pandemic is moving on and additional data are accumulating, SARS-CoV-2 seems to be associated with acute kidney injury (AKI) in severely infected and critically ill adults among other manifestations. Kidney involvement has been described in studies including mainly adult COVID-19 patients either in ICU or amongst immunocompromised ones. Based on biopsy results, vari-able forms of glomerulopathy including collapsing type, minimal change disease, membranous glomerulopathy, crescentic transfor-mation of lupus nephritis, anti-GBM nephritis and few cases of acute tubular injury have been described. 1 The novel coronavirus acts through angiotensin-converting enzyme 2 (ACE2) on body cells and since ACE2 is also expressed in tubular epithelial cells and renal podocytes, renal involvement is explained. However, data in children are variable, with a reported rate of AKI in COVID-19 hospitalised critically ill children between 1.2% and 44%. 2,3 On the other hand, nephrotic syndrome in children following SARS-CoV-2 infection has only been described as relapse of a preceding condition, as commonly seen with other viruses. 4 Only two case reports with new onset nephrotic syndrome and concur-rent gastrointestinal or respiratory symptoms due to SARS-CoV-2 have been described in literature. 5,6 Hereby we describe the fi rst paediatric case with new-onset nephrotic syndrome as the only presenting symptom in the course of COVID-19 infection.