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COVID-19 and Acute Kidney Injury - Direct and Indirect Pathophysiological Mechanisms Underlying Lesion Development

Antônio V B DA Silva1, João DE A G Campanati1, Isadora DE S Barcelos1

  • 1Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, 45029-094 Vitória da Conquista, BA, Brazil.

Anais Da Academia Brasileira De Ciencias
|December 8, 2022
PubMed

Insights

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes COVID-19, leading to kidney injury through direct viral effects and immune system dysregulation. Understanding these mechanisms is crucial for developing new treatments for COVID-19-related acute kidney injury.

Area of Science:

  • Nephrology
  • Virology
  • Immunology

Background:

  • COVID-19, caused by SARS-CoV-2, is a global pandemic with significant mortality.
  • While primarily affecting the respiratory system, SARS-CoV-2 also impacts renal function, leading to Acute Kidney Injury (AKI).
  • AKI in COVID-19 patients is multifactorial, involving direct viral effects and indirect inflammatory responses.

Purpose of the Study:

  • To elucidate the molecular mechanisms and pathophysiology of SARS-CoV-2-induced kidney injuries.
  • To highlight the roles of the renin-angiotensin-aldosterone system (RAAS) and kallikrein-kinin system (KKS) in SARS-CoV-2 renal pathology.
  • To emphasize the contribution of hypercytokinemia and associated complications to renal damage.

Main Methods:

  • Review of existing literature on SARS-CoV-2 and kidney injury.
  • Analysis of molecular pathways affected by SARS-CoV-2, including RAAS and KKS.
  • Examination of the immune response, inflammation, and resultant organ damage.

Main Results:

  • SARS-CoV-2 directly infects renal cells, disrupting pathways like RAAS and KKS.
  • The virus triggers hypercytokinemia, an overactive immune response.
  • This exaggerated inflammation causes hemodynamic changes, hypoxia, oxidative stress, endothelial damage, and coagulopathy, leading to severe kidney damage.

Conclusions:

  • Understanding the complex interplay between viral infection and host response is key to managing COVID-19-related AKI.
  • Targeting viral entry, inflammatory pathways, and associated complications may offer therapeutic strategies.
  • Further research into these mechanisms is vital for preventing and treating kidney injury in COVID-19 patients.

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