Perinatal Acute Kidney Injury in a Preterm Neonate Associated with Maternal COVID-19 Infection: A Case Report

Effect of Perinatal maternal Coronavirus Disease-2019 (COVID-19) on growing foetus is not fully understood. There are early reports of biochemical Acute Kidney Injury (AKI) in the foetus with maternal COVID-19 infection. Present case is the first clinical case of perinatal AKI in a preterm neonate associated with maternal severe COVID-19. Preterm baby (34+4 weeks) was born to mother having COVID-19 pneumonia with raised inflammatory markers. She had history of decrease foetal movements and anhydraminos a day prior to delivery. Baby showed signs of AKI in form of weight gain, oedema and hypertension with initial serum creatinine of 3.54 mg/dL and blood urea of 95.2 mg/dL at 48 hours of age. Subsequently baby showed diuresis and improving Renal Function Tests (RFT). The foetal AKI resulted in anuria followed by anhydraminos with postnatal recovering AKI; even though the baby tested negative for COVID-19 RT-PCR, The baby did not have any clinical or biochemical evidence of asphyxia or sepsis. Possible explanation could be foetal renal hyoxic ischaemic insult due to Vasomotor Nephropathy (VMNP) or AKI due to cytokine storm in mother or direct viral injury to developing kidneys without nasopharyngeal colonisation.