Abstract: FR-PO1129
Prolonged Myoglobinuric AKI in Young Female in the Era of the COVID-19 Pandemic
Session Information
- COVID-19 - II
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Hajnoczky, Nora, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, United States
- Shenoy, Prashamsa, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, United States
- Gulati, Rakesh, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, United States
Introduction
We present a 26-year-old female with no pertinent medical history who presented to the nephrologist with persistently elevated creatinine (Cr) and urinalysis significant for microscopic hematuria without red blood cells.
Case Description
The patient reported being ill 2 months prior to presentation with symptoms of fatigue, myalgias, pharyngitis and general malaise. During her illness, she ran a marathon, treated her myalgias with NSAIDs and discontinued spironolactone for acne vulgaris. On assessment, she described ongoing symptoms of fatigue, myalgias and decreased appetite. Lab work indicated Cr of 2.15mg/dL (baseline <1 mg/dL), mild metabolic acidosis, urinalysis and urine chemistry indicated +1 myoglobulin (88.26 ng/mL, normal <21 ng/mL), and creatine phosphokinase 44 IU/L. Further studies revealed normal ANA, complements, ANCA, myositis panel and other autoimmune workup. She was diagnosed with myoglobinuric acute kidney injury (AKI) in the setting of recent viral illness, remote NSAID and spironolactone use, however the extent and persistence of her AKI was not completely understood. COVID antibody screen was positive for antinucleocapsid antibody and antispike glycoprotein antibody titer >250 units/mL. She was closely monitored with biweekly labs, encouraged to drink electrolyte rich fluids, and treated with oral sodium bicarbonate. Her Cr peaked at 2.3 mg/dL and urine myoglobin at 278.9 ng/mL, however both normalized by the fourth month. We concluded the patient likely had COVID-19 infection in November and was experiencing “long COVID” renal disease.
Discussion
COVID-19 infection can directly injure kidneys through endothelial destruction, complement activation, coagulopathy and indirectly through multiorgan damage. Large-scale studies exploring COVID-19 and AKI focus on severely ill, unvaccinated, older patients, with multiple comorbidities. There are also a handful of small case reports that have examined COVID-19 induced rhabdomyolysis requiring hemodialysis. However, there remains limited understanding of why healthy, vaccinated, young patients may develop persistent AKI and what this means for their future kidney function, even in cases where creatinine levels return to normal. This case demonstrates the importance of considering COVID-19 induced AKI, even in patients who are not at high risk of developing severe infection related illness.