A CLINICAL CASE OF SARS-CoV-2 INFECTION COMPLICATED BY NEPHROGENIC PULMONARY EDEMA AND COVID-ASSOCIATED PNEUMONITIS, ALVEOLITIS.
Russian Journal of Infection and Immunity
; 13(1):183-190, 2023.
Article
in Russian
| EMBASE | ID: covidwho-2320230
ABSTRACT
COVID-19 is a highly transmissible disease with severe course especially in patients with nephrogenic hypertensive disease and chronic kidney disease due to a higher incidence of all-type infections than in the general population. The aim of the study is to describe a clinical case of SARS-CoV-2 infection complicated by nephrogenic pulmonary edema and COVID-associated pneumonitis, alveolitis. Description of the case. Patient K.S., born in 1975, was hospitalized 24 hours after symptom onset at emergency hospital due to complaints of increased blood pressure up to 180-200/110-120 mm Hg, temperature up to 38.7degreeC, dry cough, feeling of heaviness in the chest, change in urine color. PCR smear for SARS-CoV-2 was positive. Computed tomography revealed a pattern of bilateral COVID-associated pneumonitis, alveolitis, with 75% involvement. The electrocardiogram revealed signs of left ventricular myocardial hypertrophy. Ultrasound examination showed numerous cysts in the kidneys. Urinalysis at admission leukocytes - 499, erythrocytes - 386. Glomerular filtration rate (CKD-EPI 29 ml/min/1.73 m2) and corresponds to stage IV of chronic kidney disease. Coagulogram fibrinogen 32.3 (1.6-4.0) g/l, D-dimer 663 (0-250). Despite the treatment, the patient's condition worsened, the phenomena of cardiopulmonary and renal insufficiency increased, which led to a fatal outcome. During a virological study of sectional material:
SARS-CoV-2 coronavirus RNA was found in the lung and kidneys. Signs of bilateral COVID-associated pneumonitis, alveolitis with diffuse cellular infiltrates in combination with changes in the alveolar apparatus, signs of pulmonary edema were revealed. Heart-related signs - swelling of the interstitium, fragmented muscle fibers, some of them hypertrophied, a wave-like deformation of cardiomyocytes, blurring of the transverse striation. Arteries with thickened sclerosed walls. In the kidneys - diffuse damage to the proximal tubules of the nephron with areas of cortical and proximal necronephrosis, areas of fibrinoid swelling. Conclusion. The cause of death of a 45-year-old patient was a severe course of bilateral COVID-associated pneumonitis, alveolitis, which contributed to the development of renal medullary hypoxia and type 1 cardiorenal syndrome, which led to early nephrogenic pulmonary edema.Copyright © 2023 Saint Petersburg Pasteur Institute. All rights reserved.
alveolitis; kidneys; nephrogenic lung edema; pneumonitis; polycystic disease; sovid-19; adult; artery; article; cardiac muscle cell; cardiorenal syndrome; case report; cause of death; cell infiltration; chronic kidney failure; clinical article; clinical assessment; complication; computer assisted tomography; coronavirus disease 2019; dry cough; electrocardiogram; electrocardiography; elevated blood pressure; erythrocyte; fatality; female; glomerulus filtration rate; heart hypertrophy; heart left ventricle; human; human cell; hypoxia; interstitium; kidney cyst; kidney failure; kidney proximal tubule; leukocyte; lung alveolitis; lung alveolus; lung edema; male; middle aged; nephron; nonhuman; outcome assessment; pneumonia; Severe acute respiratory syndrome coronavirus 2; skeletal muscle cell; swelling; thorax; ultrasound; urinalysis; urine color; D dimer; endogenous compound; fibrinogen
Full text:
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Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Prognostic study
Language:
Russian
Journal:
Russian Journal of Infection and Immunity
Year:
2023
Document Type:
Article
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