Korean J Transplant.  2022 Nov;36(Supple 1):S321. 10.4285/ATW2022.F-4587.

Post-COVID emphysematous graft pyelonephritis

• Singh JI
• Dutta A
• saha T

• KMID: 2535548
• DOI: http://doi.org/10.4285/ATW2022.F-4587

Abstract

Emphysematous pyelonephritis in the allograft kidney can be a devastating illness with risk of graft loss. COVID-19 illness has been associated with both worsening of glycemic control and new onset of diabetes in susceptible population. We present a 39 years old lady who underwent kidney transplant in 2007 with mother as donor and developed new onset diabetes after transplantation (NODAT) since 2011. She was maintaining normal renal parameters on triple immunosuppressive medication and glycemic control with insulin. She suffered from severe COVID-19 illness in June 2021. She presented again in August 2021 with C/O fever, pain abdomen for 3 days and oliguria for 1 day. On evaluation she was in sepsis with impending shock and re-spiratory distress. Investigations showed leucocytosis, metabolic acidosis, hyperglycemia and worsening azotemia. Serum ketones were positive. Ultrasound abdomen showed normal graft kidney. She was managed on IV antibiotics, insulin infusion and oxygen. She showed no significant improvement hence a non-contrast computed tomography abdomen and chest was done which showed emphysematous graft pyelonephritis and fibrotic sequelae of COVID in both lungs. It was decided to con-tinue with antibiotics treatment rather than go for nephrectomy in order to save the renal allograft. She started improving with increasing urine output and oxygenation after 48 hours of treatment. She developed herpes zoster during the stay in hospital and immunosuppression had to be reduced. After 3 weeks of antibiotics she finally had complete recovery of renal function. The case shows that early empirical antibiotic treatment initiation, blood sugar control and early computed tomography scan is of paramount importance in timely diagnosis and management. COVID infection can precipitate uncontrolled diabetes and life threatening infections in immunosuppressed.