Dr Paul Nguyen1, Dr Daniela Potter1,2,3, Professor Angela Makris1,2,3
1Department of Nephrology, South Western Sydney Local Health District, Sydney, AUSTRALIA, 2University of New South Wales, Sydney, Australia, 3University of Western Sydney, Sydney, Australia
Background: Acute COVID-19 infection is known to result in a hypercoagulable state with an increased risk of both arterial and venous thrombosis. Pulmonary embolism is the most reported thrombotic complication of COVID-19, with thrombosis at other sites occurring less commonly. Here we report a case of renal infarction as a complication of mild COVID-19 infection.
Case report: A 41-year-old Caucasian male with no significant medical history presented with acute flank pain in the setting of mild, COVID-19 infection. A contrast computed tomography (CT) scan showed an area of hypoattenuation in the left interpolar region, suggestive of infarction with a differential diagnosis of renal abscess. No others risk factors for thrombosis were identified, and a prothrombotic screen (Factor V Leiden, Prothrombin G20210A, Anti-thrombin III, Protein C and S concentrations and Antiphospholipid antibodies) was negative. CT angiography did not reveal any vascular abnormalities. Urine culture was positive for E. Coli, and he was treated with a course of intravenous and oral antibiotics and anticoagulated with oral apixaban. Follow up CT imaging showed evolutionary changes consistent with the diagnosis of renal infarction.
Conclusion: Renal infarction, though rare, can occur in isolation as a complication of acute COVID-19 in the absence of other thrombotic risk factors. Further studies are needed to provide guidance on the long-term management of this condition, especially regarding the duration and effectiveness of anticoagulation.
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