The Indirect Implication of SARS-CoV-2 Resulting in Kayexalate Toxicity in a Patient with Acute Kidney Injury
Abstract
The clinical features of corona virus disease 2019 (COVID-19) are variable, but the majority of patients experience mild flu-like symptoms. The cases of severe disease include complications such as progressive pneumonia, acute kidney injury (AKI), multi-organ failure, and even death. This paper explores the association between COVID-19 and its effect on multiple organ systems and how the subsequent treatment of this dis-ease can itself lead to morbidity and mortality. We present a case that emphasizes the life-threatening gastrointestinal complications associated with the treatment of AKI in a patient with COVID-19. We conclude that the patients whose treatment regimens utilize medical resins should be closely monitored for gastrointestinal complications so as to mitigate the known adverse effects associated with these drugs, such as colonic mucosal ulceration, perforation, or even death.
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Mohanty SK, Satapathy A, Naidu MM, Mukhopadhyay S, Sharma S, Barton LM, et al. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)—Anatomic pathology perspective on current knowledge. Diagn Pathol. 2020;15(1):103. http://dx.doi. org/10.1186/s13000-020-01017-8
Tahir F, Bin Arif T, Ahmed J, Malik F, Khalid M. Cardiac manifestations of coronavirus disease 2019 (COVID-19): A comprehensive review. Cureus. 2020;12(5):e8021. http://dx.doi. org/10.7759/cureus.8021
Macera M, De Angelis G, Sagnelli C, Coppola N, Vanvitelli C-G. Clinical presentation of COVID-19: Case series and review of the literature. Int J Environ Res Public Health. 2020;17(14):5062. http://dx.doi.org/10.3390/ijerph17145062
Ge H, Wang X, Yuan X, Xiao G, Wang C, Deng T, et al. The epidemiology and clinical information about COVID-19. Eur J Clin Microbiol Infect Dis. 2020;39(6):1011-1019.. http://dx.doi. org/10.1007/s10096-020-03874-z
Pascarella G, Strumia A, Piliego C, Bruno F, Del Buono R, Costa F, et al. COVID-19 diagnosis and management: A comprehensive review. J Intern Med. 2020;288(2):192–206. http:// dx.doi.org/10.1111/joim.13091
Gagliardi I, Patella G, Michael A, Serra R, Provenzano M, Andreucci M. COVID-19 and the kidney: From Epidemiology to clinical practice. J Clin Med. 2020;9(8):2506. http://dx.doi. org/10.3390/jcm9082506
Bal A, Agrawal R, Vaideeswar P, Arava S, Jain A. COVID-19: An up-to-date review—From morphology to pathogenesis. Indian J Pathol Microbiol. 2020;63(3):358–66. http://dx.doi. org/10.4103/IJPM.IJPM_779_20
Zheng KI, Feng G, Liu WY, Targher G, Byrne CD, Zheng MH. Extrapulmonary complications of COVID-19: A multisystem disease? J Med Virol. 2020;93(1):323-335. http://dx.doi. org/10.1002/jmv.26294
Deshmukh V, Motwani R, Kumar A, Kumari C, Raza K. Histopathological observations in COVID-19: A systematic review. J Clin Pathol. 2020;74(2):76-83. http://dx.doi. org/10.1136/jclinpath-2020-206995
Gavriatopoulou M, Korompoki E, Fotiou D, Ntanasis-Stathopoulos I, Psaltopoulou T, Kastritis E, et al. Organ-specific manifestations of COVID-19 infection. Clin Exp Med. 2020;20(4):493-506.. http://dx.doi.org/10.1007/ s10238-020-00648-x
Kunutsor SK, Laukkanen JA. Renal complications in COVID-19: A systematic review and meta-analysis. Ann Med. 2020;52(7):345–53. http://dx.doi.org/10.1080/07853890.2020.17 90643
Calabrese F, Pezzuto F, Fortarezza F, Hofman P, Kern I, Panizo A, et al. Pulmonary pathology and COVID-19: Lessons from autopsy. The experience of European Pulmonary Pathologists. Virchows Arch. 2020;477(3):359–72. http://dx.doi. org/10.1007/s00428-020-02886-6
Tian S, Xiong Y, Liu H, Niu L, Guo J, Liao M, et al. Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies. Mod Pathol. 2020;33(6):1007–14. http://dx.doi.org/10.1038/s41379-020-0536-x
Kipshidze N, Dangas G, White CJ, Kipshidze N, Siddiqui F, Lattimer CR, et al. Viral coagulopathy in patients with COVID-19: Treatment and care. Clin Appl Thromb Hemost. 2020;26:1076029620936776. http://dx.doi.org/10.1177/1076029 620936776
Capuano I, Buonanno P, Riccio E, Pisani A. Acute kidney injury in COVID-19 pandemic. Nephron. 2020;144(7):345–6. http://dx.doi.org/10.1159/000508381
Ronco C, Reis T, Husain-Syed F. Management of acute kidney injury in patients with COVID-19. Lancet Respir Med. 2020;8(7):738–42. http://dx.doi.org/10.1016/S2213-2600(20)30229-0
Gabarre P, Dumas G, Dupont T, Darmon M, Azoulay E, Zafrani L. Acute kidney injury in critically ill patients with COVID-19. Intensive Care Med. 2020;46(7):1339–48. http://dx. doi.org/10.1007/s00134-020-06153-9
Yan Q, Zuo P, Cheng L, Li Y, Song K, Chen Y, et al. Acute kidney injury is associated with in-hospital mortality in older patients with COVID-19. J Gerontol A Biol Sci Med Sci. 2020;20(20):1–7. http://dx.doi.org/10.1093/gerona/glaa181
Na KR, Kim HR, Ham Y, Choi DE, Lee KW, Moon JY, et al. Acute kidney injury and kidney damage in COVID-19 patients. J Korean Med Sci. 2020;35(28):e257. http://dx.doi.org/10.3346/ jkms.2020.35.e257
Hansrivijit P, Qian C, Boonpheng B, Thongprayoon C, Vallabhajosyula S, Cheungpasitporn W, et al. Incidence of acute kidney injury and its association with mortality in patients with COVID-19: A meta-analysis. J Investig Med. 2020;68(7):1261– 70. http://dx.doi.org/10.1136/jim-2020-001407
Mushiyakh Y, Dangaria H, Qavi S, Ali N, Pannone J, Tompkins D. Treatment and pathogenesis of acute hyperkalemia. J Community Hosp Intern Med Perspect. 2011;1(4). http:// dx.doi.org/10.3402/jchimp.v1i4.7372
Long B, Warix JR, Koyfman A. Controversies in management of hyperkalemia. J Emerg Med. 2018;55(2):192–205. http://dx. doi.org/10.1016/j.jemermed.2018.04.004
Dunlap RH, Martinez R. Total colectomy for colon perforation after kayexalate administration: A case report and literature review of a rare complication. J Surg Case Rep. 2016;2016(10):1–3. http://dx.doi.org/10.1093/jscr/rjw167
Fiel DC, Santos I, Santos JE, Vicente R, Ribeiro S, Silva A, et al. Cecum perforation associated with a calcium polystyrene sulfonate bezoar—A rare entity. J Bras Nefrol. 2019;41(3):440–4. http://dx.doi.org/10.1590/2175-8239-jbn-2018-0158
Yuste C, Merida E, Hernandez E, Garcia-Santiago A, Rodriguez Y, Munoz T, et al. Gastrointestinal complications induced by sevelamer crystals. Clin Kidney J. 2017;10(4):539–44. http://dx.doi.org/10.1093/ckj/sfx013
Sterns RH, Grieff M, Bernstein PL. Treatment of hyperkalemia: Something old, something new. Kidney Int. 2016;89(3):546–54. http://dx.doi.org/10.1016/j.kint.2015.11.018
Ayoub I, Oh M, Gupta R, McFarlane M, Babinska A, Salifu MO. Colon necrosis due to sodium polystyrene sulfonate with and without sorbitol: An experimental study in rats. PLoS One. 2015;10(9):1–8. http://dx.doi.org/10.1371/journal.pone.0137636
Gonzalez RS, Lagana SM, Szeto O, Arnold CA. Challenges in diagnosing medication resins in surgical pathology specimens: A crystal-clear review guide. Arch Pathol Lab Med. 2017;141(9):1276– 82. http://dx.doi.org/10.5858/arpa.2016-0587-RA
Emmett M. A comparison of clinically useful phosphorus binders for patients with chronic kidney failure. Kidney Int Suppl. 2004(90):S25–32. http://dx.doi.org/10.1111/j.1523-1755. 2004.09005.x
Wrong O, Harland C. Sevelamer and other anion-exchange resins in the prevention and treatment of hyperphosphataemia in chronic renal failure. Nephron Physiol. 2007;107(1):17–33. http://dx.doi.org/10.1159/000106568
Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30(3):269–71. http://dx.doi.org/10.1038/s41422-020-0282-0
Wu J, Song S, Cao HC, Li LJ. Liver diseases in COVID-19: Etiology, treatment and prognosis. World J Gastroenterol. 2020;26(19):2286–93. http://dx.doi.org/10.3748/wjg.v26.i19.2286
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