Kidney Imaging Findings in a Patient with COVID-19
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A 17-year-old male with morbid obesity (BMI 47.16) but otherwise no past medical history presented with 4 days history of fever, shortness of breaths, productive cough and pleuritic chest pain. The patient has acute respiratory distress and oxygen desaturation reaching 55% in room air associated with tachypnea and tachycardia. His temperature was 38.5°C and blood pressure was 138/87 mmHg. The physical examination was unremarkable.

Laboratory findings revealed leukocytosis. A chest x-ray showed diffuse bilateral coarse reticular infiltrates. The patient was placed on BiPAP and was admitted to the ICU. A nasopharyngeal swab was performed and COVID-19 infection was confirmed. On the following day, his clinical condition worsened and he was intubated. He also developed acute kidney injury that required the initiation of hemodialysis. The serum creatinine level raised significantly from 65 to 134 µmol/L.

A CT scan of the chest, abdomen, and pelvis was obtained. The chest CT showed bilateral peripheral lower-lobe predominant ground-glass opacities, classical for COVID-19 infection but no pulmonary embolism. The abdominal CT revealed bulky kidneys with bilateral peripheral focal areas of decreased attenuation. Trans-esophageal echocardiography was normal without signs of infective endocarditis. After 7 weeks of fluctuating hospital course with supportive treatment, the patient's clinical status gradually improved. He was extubated with maintained oxygen saturation on room air. The renal impairment was resolved with cessation of hemodialysis. Renal and liver function tests as well as the inflammatory markers were normalized and the repeated throat swabs were negative. The last chest X-ray was almost normal. A repeated CT scan of the abdomen and pelvis was carried out and revealed significant improvement of the bilateral kidney changes. The patient was discharged home and continued to do well.

COVID-19 infection affecting the kidneys can manifest radiologically as bilateral peripheral low perfusion changes similar to the findings observed in patients with vasculitis and can be contributed to vasculopathy and thromboembolic manifestations associated with coronavirus infection.

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