A Case Report of a Young Female With Renal Infarction Secondary to Breakthrough COVID Infection

Abstract

COVID-19 infection is a disease that induces a hypercoagulable state that appears to be more aggressive than other conditions related to endothelial damage. The kidney, a highly vascularized organ rich in Angiotensin-Converting Enzyme 2 (ACE2) receptors, is commonly affected by COVID-19 infection. Acute kidney injury (AKI) is common in these patients and has been linked to worse outcomes. Furthermore, kidney infarction, although uncommon, has also been reported. We present the case of a 21-year-old otherwise healthy female presenting with flank pain who was found to have renal infarction in the setting of breakthrough COVID-19 infection and Oral contraceptive pill (OCP) use. Despite getting appropriate vaccination, the patient was infected. She was not hypoxic, and her kidney function was preserved. CT angiography demonstrated peripheral hypoattenuation in the right kidney compatible with infarct but no evidence of a thrombus. The patient was medically managed with anticoagulation, and supportive therapy was offered for pain control. She had clinical improvement. The follow-up at three weeks showed normal renal function. She was continued with novel oral anticoagulation (NOAC). This case demonstrates that COVID-19 infection may present renal infarction in otherwise healthy young individuals even after appropriate vaccination. Early recognition is essential so that appropriate therapy can be given. Long-term anticoagulation and outcomes of this entity must be studied.

Desert travels in the Atacama: making place through movement (c. 2500‐1500 cal BP)

“…Given the enormous and diverse productivity of the Atacama coast, its limited environmental fluctuations, and the stability of its resources, coastal mobility must not be solely understood as a subsistence strategy, but defined by a variety of social needs. The evidence available for the Formative Period indicates that the settlement system was comprised of small camps constructed using light, perishable materials such as sea lion skins, cactus wood, and whale bones, suggesting that they were used temporarily and were easily transportable -a practice that was also documented by historical accounts (Lizárraga 1999;Vásquez de Espinosa 1948[1630; Vivar 2001Vivar [1558). Travel made possible not only the production of enough surplus to maintain a constant flow of coastal goods to towns in the interior, but also the reproduction of a sociopolitical system through marriages, familial alliances, and common mortuary customs that involved the collective organization of labour and ritual.…”

Renal Histopathological Lesions Associated with SARS-CoV-2 Infection in Patients with no History of Kidney Disease: A Systematic Review

“…Regarding vascular lesions, the infection by SARS-CoV-2 may be associated with thrombotic microangiopathy present in renal infarction. Vasquez et al [59], reported the case of a 21year-old, healthy woman, using an oral contraceptive pill (OCP) and with a positive diagnosis for SARS-CoV-2 by PCR, presented multiple areas compatible with renal infarction in computed tomography. Excluding other precedents, COVID-19 infection and the use of OCP were accepted for this case as risk factors for the development of endothelial damage and microvascular thrombi as a cause of renal infarction [59].…”

“…Vasquez et al [59], reported the case of a 21year-old, healthy woman, using an oral contraceptive pill (OCP) and with a positive diagnosis for SARS-CoV-2 by PCR, presented multiple areas compatible with renal infarction in computed tomography. Excluding other precedents, COVID-19 infection and the use of OCP were accepted for this case as risk factors for the development of endothelial damage and microvascular thrombi as a cause of renal infarction [59]. A post-mortem histopathological analysis of 26 positive cases for COVID-19 corroborates our findings by observing severe endothelial injury in 3 cases and edema of endothelial cells with foamy degeneration in 5 cases with comorbidities.…”

A Pictorial Essay Describing the CT Imaging Features of COVID-19 Cases throughout the Pandemic with a Special Focus on Lung Manifestations and Extrapulmonary Vascular Abdominal Complications

“…A case of splenic infarction was also reported during the peak of the Delta variant wave in an unvaccinated male [ 185 ]. Rare cases of splenic infarction have been described after COVID-19 m-RNA vaccines [ 186 , 187 , 188 , 189 , 190 ] ( Figure 26 ).…”

“…Renal infarction appears in CECT as a wedge-shaped focal hypodensity. Vasquez Espinosa et al [ 190 ] reported cases of renal infarction in a young woman who was fully vaccinated. Rare cases of renal infarction have been reported in asymptomatic COVID-19 infections [ 177 ].…”