Bilateral Renal Artery Thrombosis in a Patient With COVID-19

El Shamy, Osama; Munoz-Casablanca, Nitzy; Coca, Steven; Sharma, Shuchita; Lookstein, Robert; Uribarri, Jaime

Reports of the incidence of acute kidney injury (AKI) in patients with COVID-19 have varied greatly from 0.5% to as high as 39%, with onset generally within 7 days from time of admission(1). The nature of the kidney insult is acute tubular necrosis, immune cell infiltration or rhabdomyolysis as demonstrated in autopsy reports(2)(,)(3). Moreover, infection with COVID-19 has been associated with coagulation abnormalities(4), as well as complement-mediated generalized thrombotic microvascular injury(5). These patients have been found to have high D-dimer, fibrin degradation product and fibrinogen values, an elevated INR, normal PTT and normal platelet counts. Renal artery thrombosis is a rare condition, the most common cause of which is atrial fibrillation. However, bilateral completely occlusive renal artery thrombosis is even rarer. We present a case of a patient with COVID-19 on systemic anticoagulation who presented with a serum creatinine of 6.04mg/dL requiring the initiation of kidney replacement therapy and was found to have bilateral renal artery thrombosis.