Acute kidney injury in COVID-19: a case-report
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NEPHROLOGY - LETTER TO THE EDITOR
Acute kidney injury in COVID‑19: a case‑report Marco Di Mauro1 · Marco Giuseppe Migliaccio1 · Riccardo Ricciolino1 · Giorgio Spiniello1 · Vincenzo Carfora1 · Nicoletta Verde1 · Filiberto Fausto Mottola1 · Nicola Coppola2 Received: 27 July 2020 / Accepted: 31 August 2020 © Springer Nature B.V. 2020
Editor, A 81-year-old-Caucasian- female with a history of rheumatoid arthritis in chronic treatment methotrexate and metilprednisolone showed fever and chills partially responsive to antibiotic therapy, and dry cough. Since the persistence of the symptoms, she underwent an oropharyngeal swab for SARS-CoV-2-RNA, resulted positive and was hospitalized at our COVID-19 unit. A thoracic CT scan showed bilateral interstitial pneumonia with ground glass opacities. At the admission, the patient didn’t need oxygen therapy, and PaO2/FiO2 at haemogasanalysis was 319. Her clinical parameters and lab tests were in the normal range (Table 1), except for mild anemia and high D-dimer. A therapy with lopinavir/ritonavir, hydroxychloroquine, enoxaparine was started. During the observation, at day 4 from hospitalization, she experienced progressive dyspnoea and hypoxemia despite a respiratory support with Venturi Mask (FiO2 24/28%). Suspecting pulmonary embolism (PE), a thoracic angio-CT scan was performed, resulted negative for PE, but suggestive of an interstitial involvement more severe than the previous CT. Adjunctive therapy with tocilizumab and metilprednisolone was started. During the following days, the patient developed hypotension, oliguria and impaired renal function, with the lower glomerular filtration rate (GFR) of 16 mL/min, corresponding to a serum creatinine
Marco Di Mauro and Marco Giuseppe Migliaccio contributed equally to the paper. * Nicola Coppola [email protected] 1
Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Section of Infectious Diseases, Department of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania “Luigi Vanvitelli”, Via L. Armanni 5, 80131 Naples, Italy
2
(SCr) of 2.7 mg/dL, 3 days after the angio-CT scan (day 7 from hospitalization, Table 1). So, a contrast induced nephropathy (CIN) was suspected, and intravenous hydration therapy started. The patient did not drink any water, and also presented clinical signs of dehydration. Urinalysis was normal. She showed a restoration of a normal diuresis and improvement of renal function (SCr and GFR), although never as normal as before the admission. She also developed unexplained anemia and thrombocytopenia, initially interpreted as related to enoxaparine, but more probably related to COVID-19. After 30 days of hospitalization, and two swab test resulted negative for SARS-CoV2, the patient was discharged in a good respiratory and clinical condition. Analyzing the possible causes of acute kidney injury (AKI), we can reasonably consider it as a CIN, for the onset of the renal function impairment occurred 3 days after int
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