COVID-19 Manifesting as Renal Allograft Dysfunction, Acute Pancreatitis, and Thrombotic Microangiopathy: A Case Report

Abstract

Coronavirus disease 2019 (COVID-19) is associated with high morbidity and mortality worldwide in both the general population and kidney transplant recipients. Acute kidney injury is a known complication of COVID-19 and appears to most commonly manifest as acute tubular injury on renal biopsy. Coagulopathy associated with COVID-19 is a known but poorly understood complication that has been reported to cause thrombotic microangiopathy on rare occasions in native kidneys of patients with COVID-19. Here, we report the first case of biopsy-proven thrombotic microangiopathy in a kidney transplant recipient with COVID-19 who developed acute pancreatitis and clinical features of microangiopathic hemolytic anemia. The patient recovered with supportive care alone.

Fig 1

Serum creatinine (solid line) and platelet count (dashed line) throughout the course of illness and follow-up period.

Fig 2

Histopathologic and ultrastructural findings on renal biopsy. (A) Hematoxylin and eosin--stained and (B) Jones methenamine silver--stained glomeruli demonstrating luminal closure with intimal edema, fibrin thrombi, and fragmented red blood cells in the hilar arterioles (400.. magnification). (C) Small artery with fibrin thrombus and fragmented red blood cells (hematoxylin and eosin stain; 400.. magnification). (D) Electron micrograph showing wrinkling of the glomerular basement membrane with endothelial cell swelling (4800.. magnification).