Kidney Infarction in Patients With COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) is a contagious life-threatening infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent findings indicate an increased risk for acute kidney injury during COVID-19 infection. The pathophysiologic mechanisms leading to acute kidney injury in COVID-19 infection are unclear but may include direct cytopathic effects of the virus on kidney tubular and endothelial cells, indirect damage caused by virus-induced cytokine release, and kidney hypoperfusion due to a restrictive fluid strategy. In this report of 2 cases, we propose an additional pathophysiologic mechanism. We describe 2 cases in which patients with COVID-19 infection developed a decrease in kidney function due to kidney infarction. These patients did not have atrial fibrillation. One of these patients was treated with therapeutic doses of low-molecular-weight heparin, after which no further deterioration in kidney function was observed. Our findings implicate that the differential diagnosis of acute kidney injury in COVID-19-infected patients should include kidney infarction, which may have important preventive and therapeutic implications.

Keywords: Coronavirus disease 2019 (COVID-19); acute kidney injury (AKI); anticoagulation; arterial thrombi; case report; computed tomography (CT); kidney infarction; renal complications of COVID-19; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); thrombotic events.

Figure 1

Computed tomography images from patients (A, B) 1 and (C-D) 2. (A) Axial and (B) coronal direction in the portal venous phase shows multiple perfusion defects (arrows) in the kidney allograft, most pronounced in the upper pole. (C) Axial and (D) coronal direction in the portal venous phase indicates a wedge-shaped perfusion defect dorsolateral in the interpolar area of the left kidney (arrows). Not shown, there were also multiple smaller perfusion defects visible in the upper and lower poles of both kidneys.