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Kidney Week

Abstract: PO0816

Rhabdomyolysis in COVID-19 Patient Requiring RRT

Session Information

Category: Trainee Case Report

  • 000 Coronavirus (COVID-19)

Authors

  • Hamdani, Muhammad usama shah, University of Florida College of Medicine, Gainesville, Florida, United States
  • Carlson, Jeremy, University of Florida College of Medicine, Gainesville, Florida, United States
  • Zahid, Hasan, University of Florida College of Medicine, Gainesville, Florida, United States
Introduction

Rhabdomyolysis is characterized by the release of intracellular muscle contents into the circulation. Of the 1099 patients affected by Covid-19 in China, only 0.2% had rhabdomyolysis.

Case Description

A 52 year old African American female with past medical history of Diabetes and hypertension presented to the ER with 7 days of worsening fever, chills, myalgias, nausea, vomiting, dyspnea, loss of sense of taste and smell. Her home medications included metformin and Candesartan-HCTZ, however, she had been off these medications for the last seven days. She was not on statins. She was a healthcare worker at a nursing home that had a recent outbreak of the novel Coronavirus with 51 positive cases. In ER, she was febrile, tachypneic with WBCs of 11.8 thousands/mm3, Creatinine of 6.68 mg/dl, BUN 76mg/dl, and creatinine kinase (CK) of 167,770 U/L. Urinalysis showed large amount of blood with 17 RBCs. Chest X-ray significant for mild patchy airspace opacity in the Lingula. She also tested positive for Covid-19. She was adequately volume resuscitated and alkalinized.
Due to her severe AKI, she did not meet criteria for Hydroxychloroquine and Azithromycin. Sarilumab was contraindicated due to transaminitis. Patient was started on hemodialysis on day 3 of admission as her creatinine continued to rise. On the 10th day after admission, her transaminitis improved and Sarilumab was administered. Repeat Covid-19 test before administering Sarilumab was positive. Her IL-6 levels checked before initiating the drug were <5 pg/mL. Her CK levels had started to trend down and were at 4880 U/L the day before starting Sarilumab. She remained oliguric and on hemodialysis with no signs of renal recovery at the time of discharge.

Discussion

Coronavirus has a huge range of presentation from asymptomatic to severe ARDS. Our goal is to highlight one of the complications of the novel corona virus leading to acute renal failure requiring hemodialysis.

Chest X-ray