H KULKARNI1, A AZLAN1, S GAN1, S VASIKARAN1, G WONG2, K PATANKAR1
1East Metro Health Services – Royal Perth Hospital, Perth, Australia, 2Western Sydney LHD- Westmead Hospital, Westmead, Australia
Background: Effects of COVID-19 in SPKTR with its consequences on renal and pancreatic function is reported for the first time.
Case Report: 36 years male SPKTR (4/6 mismatch) was admitted with COVID-19 on 7.5 months after an eventful transplantation with serum creatinine 95 umol/L, no albuminuria and normal pancreatic function – off insulin. Immunosuppression included thymoglobulin induction, Tacrolimus, mycophenolate and prednisolone. Chest X ray showed minimal degree of central pulmonary venous congestion. Low flow nasal oxygen was given for mild tachypnoea for 24 hours. Admission was prolonged for 4 days due to accidental overdose of Tacrolimus (4 times the usual dose) and was discharged home with no concerns.
Findings during admission include:
1) Acute renal dysfunction (Day 1) on admission (S Creatinine 119 umol/L) reverted to baseline in 4 days, despite accidental overdose of Tacrolimus.
2) Metabolic acidosis on admission (S bicarbonate 16) reverted to baseline on day 9.
3) New onset albuminuria (U ACR 56.4 mg/mmol) measured for the first time on day 53 did resolve on day 67.
4) Social isolation lead to weight gain of 6.1 kg on Day 53 was short lived.
5) Asymptomatic transient hypoglycaemia (Blood Glucose 2.0 mmol/L) on day 53 with Serum Insulin 28- 31 mU/L (N <12), C-Peptide 0.83 to 0.99 nmol/L (0.2-0.9) and negative Insulin antibodies reflected transient increase in beta cell dysfunction, in settings of insulin resistance (weight gain, low dose steroids) with beta-cell dysfunction also perturbed by tacrolimus use was considered.
Conclusion: SPKTR after COVID-19 infection experienced had short term effects on renal function and metabolic events with no consequences.
Dr Azlan is an Advanced Trainee in Nephrology and has interests in bedside ultrasound and interventions guided by his pocket ultrasound machine.