Acute kidney injury due to myoglobin cast nephropathy in the setting of coronavirus disease 2019-mediated rhabdomyolysis: a case report

Abstract

Background: We present this case of coronavirus disease 2019-associated acute kidney injury with rhabdomyolysis-with noteworthy renal biopsy findings demonstrating myoglobin cast nephropathy-to add to the limited literature on coronavirus disease 2019-related acute kidney injury and rhabdomyolysis.

Case presentation: A 67-year-old Caucasian man presented to our hospital with 3 weeks of malaise and decreased oral intake and several days of abnormal taste, poor appetite, decrease urine output, gastrointestinal symptoms, and myalgias, and was ultimately diagnosed with coronavirus disease 2019. His hospital course was complicated by acute kidney injury and, upon workup of his renal failure, was diagnosed with myoglobin cast nephropathy due to coronavirus disease 2019-mediated rhabdomyolysis. Ultimately, his renal function improved following hydration back to his baseline 6 weeks after his initial diagnosis of coronavirus disease 2019.

Conclusions: Given our limited knowledge of manifestations of coronavirus disease 2019, it is important to have a more in-depth understanding of the spectrum of disease of coronavirus disease 2019, which can affect various organ systems, including the kidney, and the manifestations of end-organ damage associated with it. We present this case to highlight a rarely reported finding of myoglobin cast nephropathy due to coronavirus disease 2019-mediated rhabdomyolysis.

Keywords: Acute kidney injury; COVID-19; Case report; Myoglobin cast nephropathy; Rhabdomyolysis; SARS-CoV-2.

Fig. 1

Trend of the creatinine level in the blood during hospitalization

Fig. 2

Horseshoe kidney in A transverse and B coronal view of CT abdomen

Fig. 3

A Renal biopsy histopathology under light microscopy with immunohistochemistry strongly positive for myoglobin within casts in tubules (shown by arrows) (cell marque, original magnification, 200×). B Granular casts with diffuse acute tubular injury (hematoxylin and eosin; original magnification, 200×). C Ultrastructural studies showing corrugation of glomerular basement membranes and segmental foot process effacement (original magnification, 6300×)