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COVID-19 and the Kidney: Recent Advances and Controversies

Steven Menez1, Chirag R Parikh1

  • 1Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

Seminars in Nephrology
|November 26, 2022
PubMed

Insights

Coronavirus disease-2019 (COVID-19) frequently impacts kidneys, causing acute kidney injury (AKI) and long-term complications. Certain patients, especially those with APOL1 high-risk genotype, face heightened risks for adverse kidney outcomes.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Virology

Background:

  • Kidney involvement is a significant complication of COVID-19, affecting both short-term and long-term outcomes.
  • Understanding of COVID-19's impact on kidney health has evolved throughout the pandemic, with initial focus on acute kidney injury (AKI) in severe cases.

Purpose of the Study:

  • To review key aspects of COVID-19-associated kidney disease.
  • To compare COVID-19 AKI with AKI in other settings.
  • To explore viral mechanisms and identify high-risk patient groups for adverse kidney outcomes.

Main Methods:

  • Review of existing literature on COVID-19 and kidney outcomes.
  • Analysis of the association between COVID-19-associated AKI and inpatient mortality/disease severity.
  • Discussion of viral tropism, ACE-2 binding, and APOL1 genotype in relation to kidney risk.

Main Results:

  • COVID-19-associated AKI shares similarities with AKI from other causes, but unique aspects warrant further investigation.
  • The role of direct kidney tropism by SARS-CoV-2 remains debated, with potential implications for ACE-2 binding.
  • Patients with APOL1 high-risk genotype are identified as a high-risk group for adverse kidney outcomes.

Conclusions:

  • Continued research is crucial for managing COVID-19's long-term kidney sequelae.
  • Identifying high-risk patients, such as those with APOL1 high-risk genotype, is essential for targeted outpatient management.
  • Biomarkers of kidney injury, inflammation, and repair hold prognostic value for COVID-19 patients.
Keywords:
APOL1Acute kidney injuryCOVID-19chronic kidney disease

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