A 49-year-old male presented to the emergency room with complaints of cough and shortness of breath started worsening for one week.

Associated symptoms included fever, chills, and generalized body aches. The patient was seen to be hypoxic in the emergency room, requiring oxygen through a nasal cannula.

Medical history

• Past medical history was significant for type 2 diabetes mellitus, hypertension, dyslipidaemia, depression, and gastroesophageal reflux disease.
• The patient had a 28-pack-year smoking history and quit smoking four years ago.
• The patient denied any recent travel history.
• The patient had no significant family history.
• Patient denied any chest pain, orthopnoea, paroxysmal nocturnal dyspnoea, or swelling of his extremities.

Other medications

Metformin1000 mg twice a day oral, Hydrochlorthiazide 25 mg oral, amlodipine 10 mg oral, duloxetine 60 mg oral, atorvastatin40 mg oral, lisinopril 40 mg oral, aspirin 81 mg oral.

Vital tests

Initial vital signs showed a blood pressure of 132/89 mm Hg, heart rate of 88 beats per minute (bpm), oxygen saturation of 805 on room air, which improved to 895 on a 5 L nasal cannula, respiratory rate of 30 breaths /min and temperature of 99.1â—¦ F

Physical examination showed an unkempt obese male with mild tachypnoea and coarse breath sounds bilaterally. Rest of the vital examination was within normal limits.

Laboratory examination

• Laboratory data showed normal haemoglobin at 13.9 g/dL and platelet count of 220 K/mm3.
• Liver function tests were within normal limits
• Lactic acid was slightly elevated at 1.7 mmol/L
• His influenza A and B testing was negative.
• Chest X-ray PA and lateral view revealed bibasilar infiltrate consistent with bilateral pneumonia.
• The patient had a CT of the chest with IV contrast showing bilateral ground-glass opacities.
• The patient’s nasopharyngeal swab was sent for COVID 19 testing, and he was placed in isolation.
• The patient was transferred to the intensive care unit due to worsening hypoxic respiratory failure and renal function.

What will be your course of management?

Read the full case from

Chenna A, Konala VM, Bose S, Roy S, et al. Acute kidney injury in a case series of patients with confirmed COVID 19: Role of angiotensin-converting enzyme 2 and renin angiotensin system blockade. Case reports in nephrology. Volume 2020. Article ID 8811931. DOI: 10.1155/2020/8811931.