Acute kidney injury in a covid-19 patient with Non-ST elevation myocardial infarction: case report

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) has a variety of manifestations, from asymptomatic to acute illness that can affect several organs, although being primarily associated with the respiratory system. The virus binds to angiotensin-converting enzyme-2 (ACE-2) receptors in humans and the expression of ACE-2 in heart and kidneys explains the association of COVID-19 with the renal and cardiovascular systems. Case description: Male, 62-year-old, was admitted to the emergency room (ER) for presented shortness of breath, angina pain, and gastric pain. He was a smoker and denied having comorbidities. At arrival, an examination of vital signs and physical showed tachypnea, tachycardia, hypertension, and bilateral crackles. The electrocardiography (ECG) showed left ventricular hypertrophy and Non-ST-Elevation in anterolateral. The chest x-ray showed pneumonia and cardiomegaly. Laboratory findings showed that decreased renal function and Polymerase Chain Reaction (PCR) test was positive, and increased in serum Troponin level supported the diagnosis of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2) pneumonia with Non-ST elevation myocardial infarct (NSTEMI) and Acute Kidney Injury (AKI). Loading of Aspilet, Clopidogrel, Atorvastatin, and Thrombolysis with Fondaparinux was done. The following day, transthoracic echocardiography was performed anterolateral regional wall motion abnormality with 43% of Left Ventricle Ejection Fraction (LVEF). Two weeks after hospital discharge, the echocardiography evaluation showed no improvement and was diagnosed with Chronic Heart Failure with New York Heart Association (NYHA) Functional Classification II et causa Coronary Artery Disease. Conclusion: Treatment of covid-19 patients with cardiovascular and renal complications is quite challenging since there is no specific guideline for COVID-19 patients with renal and cardiovascular complications.