Renal Infarcts—A Perplexing Case in the Middle of the COVID-19 Pandemic

Abstract

Renal infarction is a rare finding in children. Associations between SARS-CoV-2 infections and thromboembolic events including renal infarcts have been described in adults. Although a similar association in children has not yet been described with this pandemic, the pediatric literature is still evolving with the recognition of new manifestations including the post-infectious Multisystem Inflammatory Syndrome in Children (MIS-C). We report the rare event of multiple renal infarcts in a 6-year-old boy manifesting several features of MIS-C 9 weeks following a self-limiting febrile illness characteristic of COVID-19. An underlying Factor V Leiden mutation was identified in this child but felt to be insufficient on its own to explain his clinical presentation. As SARS-CoV-2 testing was delayed, the failure to identify viral RNA or antibodies may not exclude the virus' potential role in precipitating the infarct in this host. Given that renal infarcts have been described in adult patients with COVID-19, reporting this perplexing case where SARS-CoV-2 may have played a role, may help identify this potential complication.

Hematuria as an Early Sign of Multisystem Inflammatory Syndrome in Children: A Case Report of a Boy With Multiple Comorbidities and Review of Literature

“…On the other hand, severity of kidney dysfunction in patients with AKI did not correlate with degree of cardiac dysfunction ( 26 ). Beside AKI, other renal manifestations or urinalysis results in MIS-C patients were described only in few articles, reporting variable degrees of hematuria, proteinuria, and pyuria ( 21 , 24 , 28 ). Interestingly, abnormal urinalysis as indicator of renal parenchymal injury was present in a significant proportion of AKI patients ( 21 , 24 ).…”

“…Consequently, increased plasma levels of the terminal complement complex (sC5b9) suggest that complement activation and thrombotic microangiopathy are prevalent in COVID-19 and MIS-C patients ( 21 ). Although many of the described patients beside IVIG required an additional treatment with glucocorticoids, antibiotics, biological agents, and even plasmapheresis and renal replacement therapy, in many complete recovery was reported ( 10 , 17 , 22 , 23 , 28 , 29 ).…”

An extremely rare cause of flank pain: Answers

“…Only one pediatric renal infarction case, thought to be associated with MIS-C, has been reported so far. This case, which was thought to be MIS-C in the foreground with its clinical findings, was reported to be evaluated as idiopathic renal infarct, since no evidence of COVID-19 could be found [ 19 ]. To the best of our knowledge, our patient is the first reported pediatric case of renal infarction associated with CAC.…”

Unusual Presentation of Multisystemic Inflammatory Syndrome

“…Thrombotic complications like splenic infarction and cerebral strokes are also common manifestations [ 5 ]. On the other hand, renal infarctions are rare, and only a few cases reported in patients with COVID-19 pneumonia have developed renal infarctions [ 6 – 8 ]. Based on this evidence, one can see that the above patient presented with almost all the clinical signs making the diagnosis even stronger.…”