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Deprecated: Implicit conversion from float 243.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Kidney+Med 2022 ; 4 (7): 100492 Nephropedia Template TP
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Osmotic Tubulopathy and Acute Thrombotic Microangiopathy in a Kidney Transplant Recipient With a Breakthrough SARS-CoV-2 Infection #MMPMID35637695
Fahim P; Nicolaysen A; Yabu JM; Zuckerman JE
Kidney Med 2022[Jul]; 4 (7): 100492 PMID35637695show ga
Acute kidney injury is a known complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for which many different pathophysiological processes have been reported. Here, we present a case of a 45-year-old kidney transplant recipient with a breakthrough SARS-CoV-2 infection complicated by an episode of acute kidney injury 26 months after transplant. She had minimal respiratory symptoms, pancytopenia, mild hematuria, and proteinuria. A kidney biopsy revealed acute thrombotic microangiopathy (TMA) as well as an osmotic tubulopathy. The TMA was favored to be secondary to the SARS-CoV-2 infection because other etiologies for TMA, such as acute calcineurin inhibitor toxicity and acute antibody-mediated rejection, were excluded. The osmotic tubulopathy was favored to be secondary to remdesivir therapy, specifically related to the sulfobutylether-beta-cyclodextrin solubilizing carrier agent used in its formulation. The patient's kidney function improved after resolution of the SARS-CoV-2 infection. This case illustrates a unique occurrence of kidney injury secondary to SARS-CoV-2 infection and anti-COVID-19 therapy.