POS-187 ACUTE KIDNEY INJURY IN A PREGNANT PATIENT WITH COVID-19: CASE REPORT

Abstract

The Coronavirus disease 2019(COVID-19) infection in pregnancy has been presenting a lower mortality rate than other syndromes with respiratory failure and severe sepsis. However, postnatal complications can occur, requiring continuous monitoring. The COVID-19 involvement has been seen in multiple organs in humans and also the scientific literature is identifying and observing nephrology complication, like renal failure. In this situation, the dialysis may be necessary to improve maternal prognosis and increase the chances of fetal survival. A case report of a COVID-19 infected pregnant woman evolving with acute kidney injury (AKI) is described based on the patient hospital medical record and the hospital nephrology team experience.This report has the approval of the hospital ethics comittee. A female patient, 39 years old, primiparous, with a gestational age of approximately 35 weeks, without previous comorbidities, except for anxiety disorder using doxepin during pregnancy, came to the hospital with cough, hyaline sputum, dyspnea, fever and chest pain. A pulmonary infection and associated hypertensive pregnancy disease have been identified requiring her to be hospitalized with some complications like thrombocytopenia, hyperuricemia and oligoamnium. The laboratory values on admission were serum urea 27 mg/dL, serum creatinine (sCR) 0.6 mg/dL and positive PCR for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). She evolved in one day with severe acute respiratory failure due COVID-19 and thus transferred to the Intensive care unit (ICU) with the need for orotracheal intubation. She presented a chest Computed Tomography scan ground-glass opacity findings (75%), with peripheral and basal distribution and involvement of multiple lobes. Urgent caesarean section was necessary on April 15 due to the development of severe arterial hypertension and possible pre-eclampsia. The live-born fetus weighing 2220g, Apgar 6/8, was discharged after 14 days. In post-operative period of the cesarean section, the patient has reduction in the volume of diuresis 600 ml/24h and on April 16, the serum creatinine was 1.7 mg/dL with oliguria, then hemodialysis was performed. On April 26 she was extubated and evolved with clinical improvement and on May 5, she was discharged from hospital with sCR 0.6 mg/dL. During a one-week later home visit, the patient was found with maintained clinical recovery and the baby was being breastfed with weight gain and no symptoms. The case report demonstrates the impact of COVID-19 on the development of AKI during pregnancy, which based on literature, is not a frequent outcome in patients with COVID-19, especially in pregnant women. There was a possible association of hypertensive disease of pregnancy and severe kidney injury, requiring dialysis support, but in this case, with favorable maternal and fetal evolution.