A Case of Antineutrophil Cytoplasmic Antibody Vasculitis-Associated Acute Kidney Injury in a Patient With Asymptomatic COVID-19 Infection.

Vasculitis, or inflammation of blood vessels, is commonly seen with severe acute respiratory syndrome Coronavirus disease 2 (SARS-CoV-2). It is usually triggered by an autoimmune response induced by the virus, infection by the virus itself and trauma to the epithelial vessels caused by the release of cytokines. We present a case of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (pauci-immune crescentic glomerulonephritis [GN]) superimposed on acute kidney injury caused by SARS-CoV-2. Our patient is a 57-year-old Hispanic female who presented with rising creatinine and active urinary sediment in the setting of an asymptomatic COVID-19 infection. A kidney biopsy was done for declining renal function, and positive myeloperoxidase antibodies revealed pauci-immune focal crescentic glomerulonephritis. Normalization of renal function was not achieved with pulse steroids and rituximab. The patient required long-term hemodialysis. Our case here adds to the very few cases of pauci-immune crescentic glomerulonephritis reported in patients with asymptomatic SARS-CoV-2 infection. We recommend keeping this high on the differential in SARS-CoV-2-infected patients presenting with acute kidney injury.

Acute Kidney Injury Incidence, Stage, and Recovery in Patients with COVID-19.

Purpose: To determine the incidence, mortality, stage, and recovery of acute kidney injury (AKI) in COVID-19 patients and further analyze the effect of patient demographics and comorbidities on AKI incidence. Study Design: Our study looked at 1545 charts of patients over 18 years old who presented to BronxCare Hospital in NY with a positive SARS-CoV-2 PCR test. Using the KDIGO criteria, any patient presenting with a creatinine of 1.5 times the baseline or that had an increase in creatinine of 0.3mg/dL in 48 hours was diagnosed with AKI. Pregnant patients, patients with end-stage renal disease (ESRD), and patients with a history of renal transplant were excluded. Results: The incidence of AKI in COVID-19 patients was 39% (608), and the mortality rate was 58.2% (354). Of the 254 survivors, 74.8% recovered. Moreover, 42.6% (259) of patients with AKI were admitted to the ICU. Twenty-six of our patients received hemodialysis during admission. There was a statistically significant association between AKI and age, race, hypertension (HTN), diabetes mellitus (DM), hepatitis C (HCV), congestive heart failure (CHF), CKD, patient outcome, and days spent in the hospital. Of the 608 patients with AKI, 294 (48.4%), 185 (30.4%) and 129 (21.2%) had AKI stage 1, 2 and 3, respectively. Conclusion: Early resource planning is necessary when admitting COVID-19 patients. Nephrology should be consulted early, and measures should be in place to optimize outpatient follow-up in the nephrology clinic. Lastly, the use of nephrotoxic agents should be carefully considered and, if possible, avoided from the time of admission in patients with COVID-19.