A Unique Case of Acute Renal Failure and Hepatocellular Injury Occurring in the Course of a Mild SARS-CoV-2 Infection

Abstract

SARS-CoV-2 has tropism and replicates not only in the respiratory tract but also in extrapulmonary organs, such as heart, kidney, and liver. Clinical reports indicate that kidney involvement is frequent and ranges from mild proteinuria to an advanced acute kidney injury (AKI). Similarly, abnormal liver function parameters are commonly found in patients with SARS-CoV-2 infection. We describe a recent and unique case of acute renal failure and hepatocellular injury occurring in the course of a mild SARS-CoV-2 infection. A 37-year-old woman presented at ER with a 5-day history of general asthenia, fever, vomiting, and decreased urine output. She reported a positive SARS-CoV-2 antigen test performed 4 days earlier and no other comorbidities. Initial laboratory findings revealed severe renal impairment (sCr 4.57 mg/dl), non-responsive to intravenous diuretic therapy, with a need to start renal replacement therapy (RRT). She presented also with concomitant liver injury (AST/ALT 875/1349 U/L) for which a liver’s biopsy was performed, finding a morphological aspect suggestive of COVID-related microvascular damage. Further hematochemical and microbiological exams were performed to exclude infectious, metabolic, neoplastic, toxic, and autoimmune diseases, confirming the diagnosis of acute renal failure and hepatocellular injury triggered by SARS-COV-2 infection. Liver and kidney function gradually improved and RRT was stopped after three consecutive sessions. Follow-up showed complete recovery of liver and kidney function twenty-eight days after the onset of symptoms. The case illustrates the complex pathophysiology of COVID-19 that frequently may severely involve extrapulmonary organs, without giving respiratory symptoms, like in this patient.