CASE 176 (October 2020)

Clinical information

A 64-year-old man, with a history of well-controlled systemic HT, presented with SARS-CoV-2 infection, with ventilatory failure that required admission to the ICU. He presented non-oliguric KDIGO 3 acute kidney injury, which began during his stay in the ICU. He received multiple antibiotics: beta-lactams, vancomycin, meropenem; also acyclovir, among other medications. He leaves the ICU a week later and continues to require dialysis.

Given the lack of renal improvement, a biopsy was performed two weeks after admission to the ICU. Look at the images.

Figure 1. Masson's trichrome stain, X100. Note the changes in tubules and interstitium.

Figure 2. H&E, X200.

Figure 3. H&E, X400. Glomerulus with normal appearance. Note the interstitial edema.

Figure 4. Masson's trichrome stain, X400. Normal glomerulus.

Figure 5. PAS, X400.

Figure 6. Methenamine-silver stain, X400. Smooth capillary walls, without double contours, breaking or spikes.

Figure 7. H&E, X200. Areas with severe inflammatory infiltrate of mononuclear predominance, with scattered eosinophils.

Figure 8. H&E, X400. Inflammatory destruction of some tubules.

Figure 9. H&E, X400.

Figure 10. H&E, X400. Some calcium oxalate crystals in tubules.

Figure 11. PAS, X400.

Figure 12. Masson's trichrome stain, X400. Destruction of tubules, with leakage of cylinders of proteinaceous material into the interstitium..

Direct immunofluorescence for IgA, IgG, IgM, C3, C1q, kappa, and lambda: Negative.

Electron microscopy without glomerular alterations. Viral particles were not identified..

What is your diagnosis?

See diagnosis and discussion

[Top]