COVID-19 and the kidney: time to take a closer look

Abstract

Although coronavirus disease (COVID-19) is primarily a respiratory disease, the kidney may be among the target organs of infection with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Independently of baseline kidney function, acute kidney injury (AKI) is a common complication of COVID-19, associated with increased mortality and morbidity. Most frequently, COVID-19 causes acute tubular necrosis; however, in some cases, collapsing focal segmental glomerulosclerosis and direct viral tropism of the kidneys have also been documented. AKI secondary to COVID-19 has a multi-factorial origin. Even mild impairment of renal function is an independent risk factor for COVID-19 infection, hospitalisation and mortality. Dialysis patients also carry an increased risk of other severe COVID-related complications, including arrhythmias, shock, acute respiratory distress syndrome and acute heart failure. In such patients, COVID-19 may even present with atypical clinical symptoms, including gastrointestinal disorders and deterioration of mental status. More research is needed on the exact effects of SARS-CoV-2 on the kidneys. Finally, it remains to be proven whether the outcome of patients with kidney disease may be improved with anticipated vaccination programmes.

Spectrum of Kidney Injury Following COVID-19 Disease: Renal Biopsy Findings in a Single Italian Pathology Service

“…Several conditions could lead to ATN, but two significant groups were usually described: (1) ischemia-related, as observed during marked hypotension/shock conditions, such as acute pancreatitis and trauma, and (2) nephrotoxic-related agents (e.g., drugs (gentamycin, cisplatin, methotrexate), hemoglobin, myoglobin). As per the COVID-19 infection, ATN nowadays represents a well-described complication of COVID-19 hospitalized patients and the most common histomorphological pattern leading to AKI [ 101 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 ]. In our series, we observed a relevant rate of ATN in different phases (from active necrosis to later regenerative stages), and, according to the literature, it was the main pattern related to AKI.…”

Kidney Dysfunction and Its Progression in Patients Hospitalized Duo to COVID-19: Contribution to the Clinical Course and Outcomes

“…The mechanism of kidney involvement in COVID-19 appears to be multifactorial. Thus far, data suggest effects of direct viral infection (viral tropism to the renal system), hypoxia, inflammatory syndrome-mediated injury, hemodynamic instability, vascular injury, and hypercoagulable state [ 3 , 4 , 5 , 6 ].…”

“…Most of them describe acute kidney injury (AKI) in patients without previous renal impairment [ 7 , 8 , 9 , 10 ]. Data concerning the prevalence of AKI in hospitalized patients with COVID-19 vary from 0.5% to 46% [ 4 , 9 , 11 ]. In a large multicenter study, AKI was reported in 36.6% of 5449 adult patients [ 10 ].…”

“…Chan et al observed AKI in 68% of all patients admitted to an Intensive Care Unit (ICU) because of COVID-19 and 20% of them needed renal replacement therapy (RRT) [ 9 ]. Some data suggest a gradual reduction in the frequency of AKI in COVID-19, probably attributed to the rising proportion of younger patients with fewer comorbidities [ 4 , 12 ]. Existing data are heterogeneous because of patients’ race, ethnicity, age, population size, the severity of illness, time of analysis, and definitions of AKI.…”

Cardiometabolic Alterations in the Interplay of COVID-19 and Diabetes: Current Knowledge and Future Avenues

“…Notably, the indirect impact of the pandemic's effects on chronic disease management, delivery of health services, modifications in health behaviors, and rapid attention to acute complications has not been well quantified. Patients with COVID-19 experience deterioration of cardiovascular and renal systems, both of which are causes of serious complications in presence of diabetes and obesity [8,33]; treatments must be monitored very carefully, keeping in mind that their adhearance and duration is critical for reaching the theraputical goal [34]. Very recently, an international panel of experts have emphasized that up to 50% of people who have died from COVID-19 had metabolic and vascular disorders; therefore, patients with diabetes and obesity need to be carefully managed and properly treated, now more than ever [35].…”