Abstract: PUB045
AKI with Minimal Pulmonary Pathology in SARS-CoV2 Infection
Session Information
Category: Trainee Case Report
- 000 Coronavirus (COVID-19)
Authors
- Frank, Yasnowski, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, United States
- Rohatgi, Rajeev, Northport VA Medical Center, Northport, New York, United States
Introduction
SARS-CoV2 transmission occurs through infection of the upper airway epithelial cells. Though many cases are asymptomatic or mild, a significant fraction require hospitalization that is associated with morbidity and mortality. Primarily a pulmonary illness causing hypoxia and an acute respiratory distress syndrome (ARDS), SARS-CoV2 is also associated with AKI and other life-threatening systemic disorders. Generally, AKI occurs late in the course of SARS-CoV2 infection after severe pulmonary manifestations.
Case Description
49 year old African American male presented to the emergency department with 3-4 days of nausea and vomiting. He was diagnosed 10 days prior with SARS-CoV2. His past medical history is significant for pulmonary interstitial fibrosis, lupus nephritis diagnosed in 2017 with baseline serum creatinine of 3 mg/dL, and hypertension. His outpatient medications included lisinopril and hydroxychloquine. On admission his serum creatinine 28.9 mg/dL, blood urea nitrogen was 230 mg/dL, Na 133 meq/L, K 7.4 meq/L, Bicarb 11 meq/L, Cl 96 meq/L, and albumin 2.9 g/dL. His serum aldosterone 2.3 ng/dL, ACE 6 U/L, procalcitonin 1.29 ng/mL, and D-Dimer 2055. His urine dipstick showed 500mg /dL protein with moderate blood. On arterial blood gas, he had a compensated metabolic acidosis, a partial pressure of oxygen of 92.6 mm Hg on room air, and no respiratory distress. No hypotension was observed. CXR showed hazy patchy bilateral opacities, most pronounced in the lower lungs. A dialysis catheter was placed, and the patient dialyzed. The patient’s pulse oximeter remained between 96-100% on room air, D-Dimer 2055-2613, and procalcitonin < 1.29 ng/mL during his 12 day hospitalization.He was discharged on TIW hemodialysis.
Discussion
AKI due to SARS-CoV2 usually occurs in the setting of severe pulmonary disease with hypoxemia and is likely related to multiple factors including hypotension, activation of coagulation and complement cascades, and cytokine storm. On the other hand, other evidence points to renal specific tropism due to abundance of TMPRSS2 and ACE2 in renal epithelia and autopsy findings of SARS-CoV2 nucleocapsid in renal epithelia. Though the case is confounded by (1) chronic kidney disease and (2) hydroxychloroquine use, this case illustrates pure kidney failure in a patient with minimal pulmonary disease and suggests a renal specific disease due to SARS-CoV2.