Bilateral renal infarction with COVID-19 pneumonia: a case report
A 37-year-old male presented to the emergency department with complaints of bilateral flank and suprapubic pain since 2 days. The pain was sudden in onset, continuous, 5/10 in severity and aggravated with coughing and deep breathing. His past medical history was significant for hospitalization for urinary tract infection with development of ureteral strictures requiring stents 5 years ago. There was no family history of cancer or blood disorders.\nAt presentation, his vitals were normal with blood pressure of 100/75 mm Hg. On examination, he was non-toxic, alert, oriented and in pain. Physical examination was significant for bilateral costovertebral angle tenderness. Imaging showed bilateral pneumonia on X-ray and computed tomography (CT) of chest. Contrast enhanced CT of abdomen showed brisk excretion of contrast, no hydronephrosis and bilateral wedge-shaped non-enhancing areas in the renal parenchyma consistent with infarcts ().\nLabs were significant for positive COVID-19 infection on reverse transcription-polymerase chain reaction of nasal swab and negative for IgG antibodies. Serum creatinine, blood urea nitrogen (BUN) and urinalysis were normal. Hypercoagulability workup including platelet count, prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), Factor V levels and mutation analysis, antineutrophil cytoplasmic antibodies (ANCA), complement, anti-double-stranded DNA, cardiolipin antibody, beta-2-microglobulin and serum homocysteine were all normal (). Renal arterial and venous duplex showed preserved renal perfusion and no significant stenosis in the visualized segments of renal arteries.\nPatient was admitted for COVID-19 pneumonia and bilateral renal infarction. He was started on dexamethasone (6 mg) daily, Lovenox (70 mg) twice daily subcutaneously, IV fluids and supplemental oxygen at 5 liters/min through nasal canula. Because of his deranged liver enzymes, the patient was not considered a candidate for remdesivir. He received 1 unit of convalescent plasma. Pain gradually subsided and patient recovered saturating at 98% on room air at the time of discharge. He was discharged on apixaban (5 mg) daily for renal infarction.