AKI lingering in a patient with novel coronavirus

Introduction: Renal manifestations of the novel Coronavirus infection has been reported during the actual pandemic While the renal injury was more pronounced in critically ill patients, the levels of AKI, proteinuria and hematuria predicted the severity of the infection We are reporting a severe case of AKI and proteinuria with SARS-CoV- 2 infection out of proportion of its clinical manifestation Case Description: This is a 55 year old African American male patient with PMH of hypertension, aortic valve replacement on Warfarin anticoagulation and CKDIII-b with baseline eGFR of 50 ml/min/1 73m2 (creatinine of 1 5 mg/dL) and recent diagnosis of COVID-19 related gastroenteritis 10 days prior to presentation, was admitted with general malaise and decreased intake He had no cardiac nor respiratory symptoms He was afebrile and physical examination was non remarkable His labs were significant for BUN level of 129 mg/dL and creatinine of 22 0 mg/dL His blood glucose was 88 mg/dL Urinalysis showed glucose 100 mg/dL, 0-3 RBCs, 3-10 WBC with a protein/creatinine ratio of 12 8 g/g His renal ultrasound showed increased cortical echogenicity with edema His serological workup was unrevealing with negative hepatitis B and C testing, low ASO levels, negative ANA, Anti-PR3, Anti-MPO and Anti-GBM antibodies He had normal C3, C4 and negative serum immunofixation with free Kappa/lambda ratio of 1 7 His Alb was 1 7g/dL with triglycerides levels of 184 mg/dL A kidney biopsy was deferred for its high complication risk Repeatedly, the patient tested positive for SARS-CoV-2 on reverse transcription polymerase chain reaction assay with a nasopharyngeal swab During the hospital stay, the patient was non-oliguric and afebrile and was treated with supportive medical care On day 8 of hospitalization, his labs showed creatinine of 14 mg/dL and BUN of 99 mg/dL with persistent proteinuria estimated at 14 g/g At present, he continues to asymptomatic and is being monitored outpatient for his kidney recovery Discussion: Variable histopathological lesions (FSGS, collapsing glomerulopathy, podocytopathy and tubular interstitial disease) has been described in the renal manifestations of the novel coronavirus While its physiopathological mechanisms remain unclear, the severity of proteinuria and renal injury observed in this clinically asymptomatic patient highlight an unusual infection-driven mechanism