Thrombotic Microangiopathy in a Kidney Transplant Patient With COVID-19

Arturo Bascuñana; Antonia Mijaylova; Almudena Vega; Nicolás Macías; Eduardo Verde; Maria Luisa Rodríguez-Ferrero; Andrés Delgado; Javier Carbayo; Marian Goicoechea

doi:10.1016/j.xkme.2020.09.014

Thrombotic Microangiopathy in a Kidney Transplant Patient With COVID-19

Kidney Med. 2021 Jan-Feb;3(1):124-127. doi: 10.1016/j.xkme.2020.09.014. Epub 2020 Dec 10.

Authors

Arturo Bascuñana¹, Antonia Mijaylova¹, Almudena Vega¹, Nicolás Macías¹, Eduardo Verde¹, Maria Luisa Rodríguez-Ferrero¹, Andrés Delgado¹, Javier Carbayo¹, Marian Goicoechea¹

Affiliation

¹ Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Abstract

Kidney transplant recipients are at increased risk for infection, including coronavirus disease 2019 (COVID-19), given ongoing immunosuppression. In individuals with COVID-19, complications including thrombosis and endothelial dysfunction portend worse outcomes. In this report, we describe a kidney transplant recipient who developed severe thrombotic microangiopathy with a low platelet count (12 ×10⁹/L), anemia (hemoglobin, 7.5 g/dL with 7% schistocytes on peripheral-blood smear), and severe acute kidney injury concurrent with COVID-19. The clinical course improved after plasma exchange. Given this presentation, we hypothesize that COVID-19 triggered thrombotic microangiopathy.

Keywords: COVID-19; acute kidney injury; kidney transplant; thrombotic microangiopathy.

Publication types

Case Reports