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Pathology of COVID-19-associated acute kidney injury

Purva Sharma1,2, Jia H Ng1, Vanesa Bijol2,3

  • 1Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, NY, USA.

Clinical Kidney Journal
|April 2, 2021
PubMed

Insights

Acute kidney injury (AKI) is a frequent complication in COVID-19 patients. This review details kidney pathologies, with acute tubular injury being most common, aiding in AKI management and patient survival.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pathology

Background:

  • Acute kidney injury (AKI) is a significant complication in hospitalized coronavirus disease 2019 (COVID-19) patients.
  • The incidence of AKI in COVID-19 cases varies widely, ranging from 0.5% to 80%.
  • Understanding the kidney pathology in COVID-19 is essential for effective AKI management and improving patient outcomes.

Purpose of the Study:

  • To review and summarize the diverse kidney pathologies observed in patients with COVID-19.
  • To consolidate findings from published case reports and series on COVID-19-associated kidney injury.
  • To provide insights into the pathological mechanisms underlying AKI in the context of COVID-19.

Main Methods:

  • Systematic review of published literature on kidney pathologies in COVID-19 patients.
  • Analysis of data from live kidney biopsies and autopsy findings.
  • Compilation of reported cases and case series detailing renal manifestations of COVID-19.

Main Results:

  • Acute tubular injury is the most frequently identified kidney pathology in COVID-19 patients.
  • Collapsing glomerulopathy and thrombotic microangiopathy are also observed in kidney tissues.
  • Less common findings include anti-neutrophil cytoplasmic antibody vasculitis, anti-glomerular basement membrane disease, and podocytopathies.
  • Direct viral infection of the kidney was not a common finding in the reviewed literature.

Conclusions:

  • COVID-19 is associated with a spectrum of kidney pathologies, predominantly acute tubular injury.
  • While direct viral invasion may occur, other mechanisms likely contribute significantly to AKI in COVID-19.
  • Further research into the pathogenesis of COVID-19-related kidney disease is warranted to guide clinical practice.

Keywords:
AKIATNCOVANCOVID-19TMAcollapsing glomerulopathypathology

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