Mumbai: Rare Covid-19 reaction in patient with transplanted kidney

Krishna Mehta’s father had donated a kidney to him

Doctors at P D Hinduja hospital are faced with a rare adverse reaction from Covid-19 in a 22-year-old south Mumbai resident. Krishna Mehta had undergone a kidney transplant six years ago and he was fine until he contracted Coronavirus in April this year. His doctor said Krishna's transplanted kidney is functioning only 10 per cent now. Moreover, his Covid-19 antibody levels are pretty high for a kidney patient, he added.

"Krishna is studying at Indian Institutes of Management (IIM) Lucknow. Around the second week of April, students were sent home as the campus had many Covid-19 cases. Krishna tested positive 10 days after coming home," said Kunal Mehta, his father.

He was quarantined and treated at home, as he only had one episode of fever and had a runny nose for three days. "He was absolutely fine and was on basic medications. It was only after recovery that we realised its impact," said Kunal.

As part of a routine check-up, Krishna underwent a kidney profile test and the results shocked both the doctors and his family.

"Krishna's kidney, donated by his father, was functioning normally until he got Covid-19. Initially we weren't convinced that Covid-19 had precipitated the rejection. We did a biopsy and saw a severe rejection, which is normally seen in the first few days post-transplant... Only 10 per cent of his kidney was functioning," said his doctor Jatin Kothari, nephrologist at P D Hinduja hospital.

Dr Kothari consulted experts from Delhi and abroad, and everyone concluded that Covid-19 seems to be the reason.

"Normally, a rejection of a transplanted organ happens only when the patient stops taking medications, but he was taking the immunosuppressant regularly. Since the presentation was unique, we took help from other experts and ruled out all possibilities causing organ rejection and concluded that Covid-19 has to be the reason," he said.

His Covid-19 antibody levels were also checked and found to be very high. "In transplant patients, immunity is not good and we have seen that they do not develop antibodies easily. His case [high antibody levels] is unique," said Dr Kothari.

Krishna is presently undergoing plasmapheresis, a process similar to dialysis in which the blood is filtered out and harmful antibodies are removed. "He has also been given a drug to stop further rejection and prevent any more damage. As of now, he is not on dialysis. Plasma treatment will stop next week. Then we will wait and watch," said Dr Kothari, who plans to present the case in a medical journal.

A data analysis done on approximately 1,800 Covid-19 patients admitted at Hinduja showed 10 per cent had kidney injury or temporary kidney failure.

"Our investigation only indicates that it was an abnormal response of the kidney to the Coronavirus. It also highlights the fact that the virus reaction is unknown in kidney patients. There is no defined course of treatment and it is indeed distressing," said Dr Kothari.