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Current Understanding of Clinical Manifestations of COVID-19 in Glomerular Disease

Allison Shimmel1, Salma Shaikhouni2, Laura Mariani2

  • 1College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA.

Glomerular Diseases
|February 7, 2023
PubMed

Insights

COVID-19 (SARS-CoV-2) can cause new glomerular disease or relapse in patients with existing kidney conditions. Management of immunosuppression in these patients during the pandemic presents unique challenges requiring further research.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Immunology

Background:

  • The COVID-19 pandemic caused by SARS-CoV-2 has a significant mortality rate.
  • Limited information exists on the specific impact of SARS-CoV-2 infection on patients with glomerular diseases.
  • Understanding the evolving effects of SARS-CoV-2 on glomerular health is crucial.

Purpose of the Study:

  • To review and summarize current data on COVID-19 manifestations in patients with pre-existing and de novo glomerular disease.
  • To explore the potential mechanisms of kidney injury in the context of SARS-CoV-2 infection.
  • To highlight the challenges in managing immunosuppression for glomerular disease patients during the pandemic.

Main Methods:

  • Literature review of published data on COVID-19 and glomerular disease.
  • Analysis of proposed mechanisms for kidney injury, proteinuria, and hematuria.
  • Discussion of case reports and clinical observations.

Main Results:

  • SARS-CoV-2 infection can trigger glomerular disease relapse or new-onset disease, including IgA nephropathy, ANCA vasculitis, and collapsing glomerulopathy.
  • Kidney injury may result from direct tubular injury, hemodynamic instability, hypoxic injury, or a cytokine storm.
  • The role of direct viral invasion and podocytopathy is under investigation.
  • Collapsing glomerulopathy has been observed in SARS-CoV-2 cases, particularly in individuals with specific APOL1 alleles.

Conclusions:

  • SARS-CoV-2 infection can induce de novo glomerular disease, with mechanisms still under investigation.
  • Managing patients with existing glomerular disease during COVID-19 poses significant challenges, particularly concerning immunosuppression.
  • Further research is essential to guide clinical decision-making for these patients.
Abstract

Keywords:
Chronic kidney diseaseCollapsing glomerulopathyCoronavirus diseaseGlomerular diseaseGlomerular injury

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