Fahim Peter, Nicolaysen Anthony, Yabu Julie M, Zuckerman Jonathan E
Division of Nephrology, Department of Medicine, University of California, Los Angeles, CA.
Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA.
Kidney Med. 2022 Jul;4(7):100492. doi: 10.1016/j.xkme.2022.100492. Epub 2022 May 26.
Acute kidney injury is a known complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for which many different pathophysiological processes have been reported. Here, we present a case of a 45-year-old kidney transplant recipient with a breakthrough SARS-CoV-2 infection complicated by an episode of acute kidney injury 26 months after transplant. She had minimal respiratory symptoms, pancytopenia, mild hematuria, and proteinuria. A kidney biopsy revealed acute thrombotic microangiopathy (TMA) as well as an osmotic tubulopathy. The TMA was favored to be secondary to the SARS-CoV-2 infection because other etiologies for TMA, such as acute calcineurin inhibitor toxicity and acute antibody-mediated rejection, were excluded. The osmotic tubulopathy was favored to be secondary to remdesivir therapy, specifically related to the sulfobutylether-β-cyclodextrin solubilizing carrier agent used in its formulation. The patient's kidney function improved after resolution of the SARS-CoV-2 infection. This case illustrates a unique occurrence of kidney injury secondary to SARS-CoV-2 infection and anti-COVID-19 therapy.
急性肾损伤是严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的一种已知并发症，已有许多不同的病理生理过程被报道。在此，我们报告一例45岁的肾移植受者，在移植26个月后发生突破性SARS-CoV-2感染，并并发急性肾损伤。她有轻微的呼吸道症状、全血细胞减少、轻度血尿和蛋白尿。肾活检显示急性血栓性微血管病（TMA）以及渗透性肾小管病。TMA被认为继发于SARS-CoV-2感染，因为排除了TMA的其他病因，如急性钙调神经磷酸酶抑制剂毒性和急性抗体介导的排斥反应。渗透性肾小管病被认为继发于瑞德西韦治疗，具体与制剂中使用的磺丁基醚-β-环糊精增溶载体有关。SARS-CoV-2感染消退后，患者的肾功能有所改善。该病例说明了SARS-CoV-2感染和抗COVID-19治疗继发肾损伤的一种独特情况。
