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Kidney Week

Abstract: PO0823

Rhabdomyolysis and High Catabolic State in Patients with COVID-19 Who Develop Dialysis-Requiring AKI

Session Information

Category: Trainee Case Report

  • 000 Coronavirus (COVID-19)

Authors

  • Becerra rivera, Viviam Isleny, Westchester Medical Center, Valhalla, New York, United States
  • Bustos, Aulio Elias, Westchester Medical Center, Valhalla, New York, United States
  • Gupta, Sanjeev, Westchester Medical Center, Valhalla, New York, United States
  • Kapoor, Aromma, Westchester Medical Center, Valhalla, New York, United States

Group or Team Name

  • Westchester Medical Center
Introduction

Covid-19–associated rhabdomyolysis has not been clearly established; therefore, clinicians might have low clinical suspicion for rhabdomyolysis

Case Description

We are presenting five cases where Covid-19 patients became very catabolic and developed rhabdomyolysis associated with acute kidney injury (AKI). Symptoms were shortness of breath, fever, generalized malaise one week before the presentation. At the time of admission all patients had fever, tachycardia, tachypnea and were hypoxemic. One day later they were intubated for tachypnea and worsening oxygen saturation. They were admitted to the intensive care units and were treated with intravenous hydration. All the patients eventually required pressor support. AKI developed 10 days after onset of the symptoms and it was attributed to cytokine storm, ischemic acute tubular necrosis, and rhabdomyolysis.
Intravenous furosemide was attempted with poor responses. Renal replacement therapy (RRT) was needed approximately three days after development of AKI. Continues renal replacement therapy (CRRT) was the modality used. After 3 days of interrupted therapy due to clotting, there was not improvement and overall high mortality.

Discussion

Rhabdomyolysis has been associated with many infectious diseases, including viral infections. The direct viral invasion and circulating viral toxins may directly destroy muscle cell membranes leading to rhabdomyolysis. However the excessive immune response and cytokine storms which often seen in COVID-19 can promote to high catabolic state and rhabdomyolysis and therefore it will contribute to rapid worsening on renal function. Early detection and promptly supportive treatment with RRT may help to improve the vital prognosis of COVID-19.