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Renal Considerations in COVID-19: Biology, Pathology, and Pathophysiology
Meghan E Kapp1, Agnes B Fogo1, Candice Roufouse2
1From the Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes kidney injury, including acute tubular injury and collapsing glomerulopathy. Further research is needed to fully understand SARS-CoV-2
Area of Science:
- Nephrology
- Virology
- Pathology
Background:
- Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), a global pandemic.
- Beyond pulmonary issues, a significant number of patients develop acute kidney injury (AKI).
- Postmortem examinations of severe cases reveal diffuse acute tubular injury and potential vascular thrombi.
Purpose of the Study:
- To discuss the biology, pathology, and pathogenesis of SARS-CoV-2 infection and its renal manifestations.
- To explore the molecular biology, risk factors, and pathophysiology of AKI in SARS-CoV-2 infection.
- To highlight renal pathologies observed in native kidney biopsies and autopsies.
Main Methods:
- Review of existing literature on SARS-CoV-2 and kidney injury.
- Analysis of pathological findings from native kidney biopsies and autopsies.
- Discussion of diagnostic challenges and ancillary studies.
Main Results:
- Renal biopsies show a glomerular-dominant injury pattern, including collapsing glomerulopathy, particularly in patients with APOL1 risk variants.
- Acute tubular injury is a prominent finding in fatal cases.
- Direct renal cell infection by SARS-CoV-2 is not definitively proven, and the full spectrum of renal involvement is incomplete.
Conclusions:
- SARS-CoV-2 infection is associated with diverse renal pathologies, including acute tubular injury and collapsing glomerulopathy.
- Understanding the mechanisms and full spectrum of kidney injury in COVID-19 is crucial.
- Further research is needed to clarify direct viral effects and refine diagnostic approaches.
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