Bilateral Renal Artery Thrombosis in a Patient With COVID-19

Reports of the incidence of acute kidney injury in patients with coronavirus disease 2019 (COVID-19) have varied greatly from 0.5% to as high as 39%, with onset generally within 7 days from time of admission. The nature of the kidney insult is acute tubular necrosis, immune cell infiltration, or rhabdomyolysis, as demonstrated in autopsy reports. Moreover, infection with COVID-19 has been associated with coagulation abnormalities, as well as complement-mediated generalized thrombotic microvascular injury. These patients have been found to have high D-dimer, fibrin degradation product, and fibrinogen values, an elevated international normalized ratio, normal partial thromboplastin time, and normal platelet count values. Renal artery thrombosis is a rare condition, the most common cause of which is atrial fibrillation. However, bilateral completely occlusive renal artery thrombosis is even rarer. We present a case of a patient with COVID-19 on systemic anticoagulation therapy who presented with a serum creatinine level of 6.04 mg/dL requiring the initiation of kidney replacement therapy and was found to have bilateral renal artery thrombosis.