A rare case of renal artery thrombosis and kidney infarction associated with Covid-19 infection

Abstract

COVID-19 is a multisystemic disease associated with a hypercoagulable state and prothrombotic complications, including deep vein thrombosis, pulmonary thromboembolism, as well as arterial ischemic strokes. We present a rare case of renal artery thrombosis with kidney infarction associated with SARS-CoV-2 infection in a 44-years-old male patient. Patient was hospitalized in the Covid department of our clinic and initially presented with fever, cough and dyspnea. The second day of the hospital stay, he complained of flat abdominal pain. CT angiography of the abdomen was performed which showed thrombosis of the right renal artery with the diameter of the thrombi up to 3mm and clearly delimited triangular zone of ischemia of the upper lobe of the right kidney. Selective angiography of the right renal artery was performed which revealed total occlusion of the branch of the right renal artery for the upper pole. An attempt for recanalization was not successful. The patient was discharged in a good clinical condition with recommendation for antibiotic, antiplatelet and anticoagulation therapy with LMWH. After one year follow -up the kidney ultrasound revealed a hypotrophy of the right kidney with reduced parenchyma. The prothrombogenic features of SARS-CoV-2 virus can lead to serious and life- threatening complications during or after the acute onset of the infection. Although rare, renal artery thrombosis with renal infarction has been reported as a complication of COVID-19 infection. This case highlights the importance of vigilance in thrombotic complications and their therapeutic approach in COVID-19.