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Abstract: PO0794

Rhabdomyolysis as a Complication of COVID-19: A Report of Five Cases

Session Information

Category: Trainee Case Report

  • 000 Coronavirus (COVID-19)

Authors

  • Maza Moreno, Miguel, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico
  • García Macas, Vanessa Carolina, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico
  • Herrera, Jose Luis, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Fonseca, Gandhy Thomas, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Cano, Jose Horacio, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Torres Pastrana, Juvenal, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico

Group or Team Name

  • CMN 20 de Noviembre
Introduction

COVID-19virus pandemia has caused more than 5million infected and 330thousand deaths worldwide.The incidence of acute kidney injury (AKI) is variable, from 0.5%to29.8%. Rhabdomyolysis(Rb) is a life-threatening emergency, usually manifesting as myalgia, fatigue, pigmenturia, and AKI.One of its leading non-traumatic causes are viral infections.We report 5cases of Rb associated with COVID-19.

Case Description

Of a total of 460 positive cases of COVID-19infection (real-timePCR),at the NationalMedicalCenter20deNoviembre in MexicoCity, 5were diagnosed with Rb and associated AKI(Ck>5,000U/l and KDIGO AKIcriteria).Characteristics of patients are presented in(Fig.1).Age range was from 29to64 years, only one female, all withBMI>25 kg/m2, time from admission-diagnosis of Rb was on average oneweek.Most common symptoms were fever, cough, and dyspnea(5/5), as well as abdominal pain(4/5).Only(1/5) was oliguric at diagnosis. Average Ck at diagnosis was7845 (18-165μg/L) and all cases had high levels of interleukin-6.They were managed with aggressive hydration, 2of them required renal replacement.At the the time of this report, 2 had been discharged, 2 remain hospitalized(one still on RRT), and one died.

Discussion

COVID-19patients can develop AKIprimarily due to low oral intake, sepsis, andcytokine storm. Patients with COVID-19have multiple risk factors for Rb development: viral muscle cytotoxicity, continuous hyperthermia,andcytokine storm among others.This results in a high risk ofAKI via 3mechanisms: renal vasoconstriction, tubular obstruction and direct tubular toxicity.Of note, in the described cases, abdominal pain was a common symptom and only one was oliguric.Early identification allowed timely fluid resuscitation,which underscores the importance of having a high index of suspicion.Further observations will be needed to understand the full spectrum of association between COVID-19and Rb, but is clear that these patients are at highrisk for developing AKI by these mechanisms.