Rapid deterioration of renal function following coronavirus disease 2019 in a renal transplant recipient

Abstract

Introduction The coronavirus disease 2019 pandemic emerged in December 2019. Renal transplant recipients receiving chronic immunosuppression are considered to be at a high risk of infection. Aside from upper respiratory tract symptoms, coronavirus disease 2019 has also been reported to cause acute kidney injury in 20–50% of infected cases. Case presentation A 62‐year‐old male renal transplant recipient presented with high fever, diarrhea, and cough, concurrent with rapid deterioration of graft function. The patient tested positive for coronavirus disease 2019. The pathological findings of the graft biopsy revealed diffuse flattening of tubular epithelial cells and extensive loss of the brush border in proximal tubular cells. Mycophenolate mofetil was discontinued and sotrovimab, remdesivir, intravenous immunoglobulin, and intravenous methylprednisolone were administered, resulting in gradual improvements in clinical symptoms and renal function. Conclusion We describe a case of a coronavirus disease 2019‐infected kidney transplant recipient who developed severe acute kidney injury caused by severe acute tubular necrosis.

Keywords

• acute kidney injury
• acute tubular necrosis
• COVID‐19
• graft biopsy
• renal transplantation