Abstract
Abstract Description: A 50-year-old male who was admitted to intensive care with a Coronavirus-19 diagnosis for strict handling requiring oxygen therapy. He presented distention and abdominal pain, for which an abdomen-pelvic tomography was requested, reporting lack of filling in the right renal artery and renal infarcts requiring angioplasty and double antiplatelet therapy. The evolution was favorable, and the patient was discharged. Currently, a renal Doppler reports adequate vascularization. The patient presents proper renal function. Clinical Significance: The coronavirus disease is a contagious and life-threatening infection caused by the severe acute respiratory syndrome coronavirus 2. It can lead patients to arterial and venous thrombosis. However, acute renal artery occlusion is considered a rare disease. Clinical Implications: Prompt diagnosis and treatment are important to prevent permanent kidney damage or permanent loss of kidney function. Conclusion: The underlying etiology of renal infarcts remains largely unknown at present, but it may include direct viral cytopathic effects on endothelial cells. Most patients are managed conservatively. Some cases undergo angioplasty successfully. The patient in this case received earlier treatment with doses of anticoagulant enoxaparin, and his glomerular filtration remained stable, although complementary treatment was required.
Highlights
A 50-year-old male who had no drug-allergy history was reported, but he did report a surgical history of cholecystectomy, and traumatic surgery of the right tibia-fibula
The coronavirus disease-2019 (COVID-19) is a viral illness caused by the severe acute respiratory syndrome-coronavirus-2 (SARSCoV2), and has been deemed a pandemic by the World Health Organization.[1]. SARS-CoV-2 is a single-strand RNA coronavirus, which enters human cells mainly by binding the angiotensin-converting enzyme 2 (ACE2), which is highly expressed in lung alveolar cells, cardiac myocytes, the vascular endothelium, and other cell receptors, like those of kidney and intestine.[2]. Angiotensin-II (AngII) is primarily metabolized by endothelial ACE-2 to the vasodilatory and anti-inflammatory peptide angiotensin
Hypertension, smoking, atrial fibrillation, obesity, peripheral vascular disease, previous thromboembolic events, diabetes and estro-progestin therapy are recognized as the main risk factors
Summary
A 50-year-old male who had no drug-allergy history was reported, but he did report a surgical history of cholecystectomy, and traumatic surgery of the right tibia-fibula. On 08/15, the patient reported lower right limb pain with variable temperature, a Doppler ultrasound was performed showing negative results for deep vein thrombosis. The axial abdominopelvic computed tomography image (A, B and C) revealed perfusion defects (arrows), which sharply demarcated a low attenuation lesion in the right kidney. On 08/24, an angiography was performed, with the presence of an ulcerated thrombus in the right renal artery, requiring percutaneous transluminal angioplasty (Fig. 4). It began with double antiplatelet therapy (ASA, acetylsalicylic acid and Clopidogrel) and continued with Enoxaparin. The patient improved favorably, without distension or abdominal pain, and good oral tolerance with spontaneous ventilation without oxygen requirement (97% saturation). The angiography reported an ulcerated thrombus in the right renal artery
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