Pattern and prevalence of different findings in high resolution computed tomography images in patients with coronavirus disease and kidney injury; a pilot study

Introduction: Since December 2019, an outbreak of pneumonia caused by a new coronavirus has emerged. The standard diagnostic method for COVID-19 infection is the real-time reverse transcriptase-polymerase chain reaction (RT-PCR). High-resolution computed tomography (HRCT) has been proven as a sensitive, feasible and accessible test in Iran. In addition to respiratory system, other organs could also be involved in this disease. The exact mechanism of renal involvement is unknown; however, acute kidney injury (AKI) occurs in almost 5-15% of cases. Different HRCT patterns might be associated with AKI presence and severity of the disease. Objectives: To investigate patterns and prevalence of different HRCT findings in COVID-19 patients with concurrent AKI. Patients and Methods: In this retrospective study, we reviewed all hospitalized patients with COVID-19 infection, from February to April 2020 in Razi hospital, Rasht. Twenty-two cases who had AKI were enrolled. The HRCT findings of the patients were reviewed independently by two radiologists. Percentage and prevalence of HRCT findings were analyzed in SPSS 21 software. Results: All 22 cases had multifocal distribution on HRCT. Around 95.5% had peripheral involvement, 86.4% had central zones opacity while 72.2% of cases had peribronchovascular pattern. Bilateral lung involvement was found in 90.9%, but only 9.1% had unilateral involvement. There was 59.1% of lower lobe predominance for COVID-19 involvement since sub-pleural regions were spared in 18.2% of individuals. All the patients’ HRCTs showed ground glass opacity. Reticular pattern (81.8%), consolidation (77.3%), vascular enlargement in involved zones (68.2%) and airway changes (68.2%) were the next more prevalent findings. Half of the subjects showed crazy paving, 45.5% had pleural effusion and 13.6% had also lymphadenopathy. We found 40.9% of the patients had arcade-like sign. Less frequent findings were nodular opacities (13.6%), halo sign (9.1%) and reverse-halo sign (9.1%), respectively. Conclusion: This study demonstrated that atypical patterns are likely to be more common in COVID-19 patients with kidney injury.