Development of acute kidney injury with massive granular casts and microscopic hematuria in patients with COVID-19: two
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(2020) 6:59
CASE REPORT
Open Access
Development of acute kidney injury with massive granular casts and microscopic hematuria in patients with COVID-19: two case presentations with literature review Takuya Fujimaru1* , Keiki Shimada1, Takayuki Hamada1, Kimio Watanabe1, Yugo Ito1, Masahiko Nagahama1, Fumika Taki1, Shutaro Isokawa2, Toru Hifumi2, Norio Otani2 and Masaaki Nakayama1
Abstract Background: Complications of acute kidney injury (AKI) are common in patients with coronavirus disease in 2019 (COVID-19). However, clinical characteristics of COVID-19-associated AKI are poorly described. We present two cases of severe COVID-19 patients with AKI. Case presentation: A 77-year-old woman was suspected of having vancomycin-associated AKI, and a 45-year-old man was suspected of having heme pigment-induced AKI caused by rhabdomyolysis. The granular cast, which is known to be a valuable diagnostic tool for confirming the diagnosis of acute tubular necrosis, was detected in both patients at the onset of AKI. Interestingly, both patients also developed microscopic hematuria at the occurrence of AKI, and one patient had elevated D-dimer and low platelet levels simultaneously. Conclusions: Some reports suggested that COVID-19-associated microangiopathy contributed to the kidney damage. Therefore, it is possible that our patients might have accompanied renal microangiopathy, and that this pathological background may have caused exaggerated tubular damage by vancomycin or heme pigment. The etiology of AKI in patients with COVID-19 is multifactorial. Superimposition of nephrotoxin(s) and virus-associate intra-renal microangiopathy may be a crucial trigger of kidney injury leading to severe AKI in COVID-19 patients. Therefore, in COVID-19 patients, risk factors for AKI should be taken into consideration to prevent its progression into severe AKI. Keywords: COVID-19, Acute kidney injury, Vancomycin-induced acute kidney injury, Rhabdomyolysis, Microangiopathy, Urine sediment examination
Background Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) was identified to be the cause of a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China at the end of 2019. It rapidly spread to other provinces in China and around the world. In February 2020, * Correspondence: [email protected] 1 Department of Nephrology, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan Full list of author information is available at the end of the article
the World Health Organization designated the disease COVID-19, which stands for coronavirus disease in 2019. Besides severe acute respiratory syndrome, complications of acute kidney injury (AKI) are not uncommon in patients with COVID-19. A recent study of 5449 patients who were hospitalized with COVID-19 in New York revealed that 36.6% of patients developed AKI and 14.3% required renal replacement therapy [1], and to note, AKI is significantly associated with in-hospital mortality in
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