Kidney Infarction in Patients With COVID-19

Am J Kidney Dis. 2020 Sep;76(3):431-435. doi: 10.1053/j.ajkd.2020.05.004. Epub 2020 May 29.


Coronavirus disease 2019 (COVID-19) is a contagious life-threatening infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent findings indicate an increased risk for acute kidney injury during COVID-19 infection. The pathophysiologic mechanisms leading to acute kidney injury in COVID-19 infection are unclear but may include direct cytopathic effects of the virus on kidney tubular and endothelial cells, indirect damage caused by virus-induced cytokine release, and kidney hypoperfusion due to a restrictive fluid strategy. In this report of 2 cases, we propose an additional pathophysiologic mechanism. We describe 2 cases in which patients with COVID-19 infection developed a decrease in kidney function due to kidney infarction. These patients did not have atrial fibrillation. One of these patients was treated with therapeutic doses of low-molecular-weight heparin, after which no further deterioration in kidney function was observed. Our findings implicate that the differential diagnosis of acute kidney injury in COVID-19-infected patients should include kidney infarction, which may have important preventive and therapeutic implications.

Keywords: Coronavirus disease 2019 (COVID-19); acute kidney injury (AKI); anticoagulation; arterial thrombi; case report; computed tomography (CT); kidney infarction; renal complications of COVID-19; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); thrombotic events.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / diagnostic imaging*
  • Acute Kidney Injury / drug therapy
  • Acute Kidney Injury / etiology
  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections / complications
  • Coronavirus Infections / diagnostic imaging*
  • Coronavirus Infections / drug therapy
  • Diagnosis, Differential
  • Heparin, Low-Molecular-Weight / pharmacology
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Infarction / diagnostic imaging*
  • Infarction / drug therapy
  • Infarction / etiology
  • Kidney / blood supply*
  • Kidney / diagnostic imaging*
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / diagnostic imaging*
  • Pneumonia, Viral / drug therapy
  • SARS-CoV-2


  • Heparin, Low-Molecular-Weight