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Kidney Week

Abstract: PO0126

Rhabdomyolysis as Initial Presentation of COVID-19

Session Information

Category: Trainee Case Report

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Andrade paz, Hugo, Northwell Health, Great Neck, New York, United States
  • Sachdeva, Mala, Northwell Health, Great Neck, New York, United States
  • Uppal, Nupur N., Northwell Health, Great Neck, New York, United States
Introduction

Rhabdomyolysis has infectious etiology including Mycoplasma pneumoniae infection,
Legionella, and Influenza. To date, there has been one case report from Wuhan China of a patient who developed rhabdomyolysis from COVID-19 during their hospitalization. We report a case where acute kidney injury and rhabdomyolysis was the initial presentation.

Case Description

A 57 year old African American male with history of HTN for more than 10 years, presented with complaints of decreased urine output for 3 days associated with dark urine that progressed to anuria, fever for 11 days, decreased appetite and oral intake and generalized muscle weakness. Labs on admission were notable for acute kidney injury (creatinine 1.77mg/dL) which progressed rapidly to a peak creatinine of 11.10mg/dL within 72 hours, and other electrolyte abnormalities including mild hyperkalemia and acidosis. His CPK was >92,000U/L on admission and COVID-19 PCR was positive. Other labs included: peak AST 1692 U/L and ALT 291U/L, ferritin 1436 ng/mL, 4.86mg/dL, DDimer 2330 DDU, urinalysis specific gravity 1.030 with large blood, 10RBCs, 20WBCs, urine spot protein/creatinine 2.1 and random urine sodium 65. Serologic workup was negative for glomerular etiology. He was presumed to have acute tubular necrosis from rhabdomyolysis. He was started on hemodialysis on day 3 of admission for anuria and worsening of renal function. He was maintained on hemodialysis with minimal ultrafiltration three times a week, intravenous fluid resuscitation along with intermittent doses of bumex. He received total of five hemodialysis treatments until he became non-oliguric and started showing signs of recovery. He was taken off dialysis approximately three weeks after his initial presentation. His creatinine decreased and is 1.4 mg/dL one month after being taken off of hemodialysis.

Discussion

COVID-19 has its usual presentation of fevers, shortness of breath, dry cough and myalgias. This case highlights the importance that rhabdomyolysis can be one of the only presenting features of COVID-19. Checking CPK levels should be an integral part of not only an acute kidney injury workup in the COVID-19 patient but also for any COVID-19 newly diagnosed case as this diagnosis requires prompt and specific treatment.