Are Kidneys Affected by SARS-CoV-2 Infection? An Updated Review on COVID-19-Associated AKI

Area of Science:

• Nephrology
• Infectious Diseases
• Virology

Background:

• The human kidneys are a significant target for SARS-CoV-2, leading to renal abnormalities like proteinuria, hematuria, and acute kidney injury (AKI).
• AKI is a recognized complication of COVID-19, but its precise epidemiology among infected individuals remains under investigation.

Purpose of the Study:

• To conduct a narrative review assessing the frequency and risk factors for AKI in hospitalized COVID-19 patients.
• To synthesize findings from recent surveys and explore the mechanisms of AKI development in COVID-19.

Main Methods:

• A narrative review was performed, including the latest surveys on AKI in COVID-19 patients.
• A meta-analysis of 24 reports encompassing 502,593 unique SARS-CoV-2 infected patients was conducted.
• Risk factors were identified and classified, with a focus on management, background factors, and patient comorbidities.

Main Results:

• The overall incidence of AKI among hospitalized SARS-CoV-2 patients was found to be 31.8% (range: 0.5%–56.9%).
• Risk factors for AKI include in-hospital death (RR=2.63), ICU admission (aRR=2.64), and comorbidities such as diabetes, hypertension, and advanced age.
• SARS-CoV-2 can directly infect renal tubular epithelial cells and podocytes, contributing to kidney injury.

Conclusions:

• AKI is a prevalent complication in hospitalized COVID-19 patients, with comorbidities being significant risk factors.
• The pathogenesis of AKI in COVID-19 involves both indirect mechanisms and direct viral activity on kidney cells.
• Further research is needed to elucidate the precise mechanisms of kidney injury and the impact of AKI on survival in SARS-CoV-2 patients.