RESUMO
Reports of the incidence of acute kidney injury in patients with coronavirus disease 2019 (COVID-19) have varied greatly from 0.5% to as high as 39%, with onset generally within 7 days from time of admission. The nature of the kidney insult is acute tubular necrosis, immune cell infiltration, or rhabdomyolysis, as demonstrated in autopsy reports. Moreover, infection with COVID-19 has been associated with coagulation abnormalities, as well as complement-mediated generalized thrombotic microvascular injury. These patients have been found to have high D-dimer, fibrin degradation product, and fibrinogen values, an elevated international normalized ratio, normal partial thromboplastin time, and normal platelet count values. Renal artery thrombosis is a rare condition, the most common cause of which is atrial fibrillation. However, bilateral completely occlusive renal artery thrombosis is even rarer. We present a case of a patient with COVID-19 on systemic anticoagulation therapy who presented with a serum creatinine level of 6.04 mg/dL requiring the initiation of kidney replacement therapy and was found to have bilateral renal artery thrombosis.
RESUMO
We present a case of pyeloduodenal fistula in an 89-year-old woman with history of nephrolithiasis and recurrent urinary tract infection (UTI) who presented to the emergency department with back pain. CT revealed a malrotated right kidney with a large renal stone and possible fistulous connection between the second portion of the duodenum and the right renal collecting system. Technetium-99m scintigraphy confirmed presence of the fistula. The patient declined intervention and was discharged from the hospital with oral antibiotic suppressive therapy. The patient remained clinically stable at time of follow-up 3 months later. Spontaneous pyeloduodenal fistula is an aetiology of recurrent upper or lower UTIs or persistent bacteriuria though uncommonly recognised. Diagnosis may be achieved using several modalities, including technetium-99m scintigraphy. Nephrectomy and primary fistula closure has traditionally been the treatment of choice for this condition; however, conservative management is an option for patients with intact renal function.
