Renal Considerations in COVID-19: Part 1 Biology, Pathology and Pathophysiology

• Published in: ASAIO journal (1992)
• Main Authors: Kapp, Meghan E., Fogo, Agnes B., Roufouse, Candice, Najafian, Behzad, Radhakrishnan, Jai, Mohan, Sumit, Miller, Sara E., D’Agati, Vivette D., Silberzweig, Jeffrey Irs, Barbar, Tarek, Gopalan, Tulasi, Srivatana, Vesh, Mokrzycki, Michele H, Benstein, Judith A., Ng, Yue-Harn, Lentine, Krista L., Aggarwal, Vikram, Perl, Jeffrey, Salenger, Page, Coyner, Jay, Josephson, Michelle A., Heung, Michael, Velez, Juan Carlos, Ikizler, Alp, Vijayan, Anitha, William, Preethi, Thajudeen, Bijin, Slepian, Marvin J.
• Format: Journal Article
• Language: English
• Published: by the American Society for Artificial Internal Organs 29-06-2021
• ISSN: 1058-2916
• DOI: 10.1097/MAT.0000000000001530

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has emerged into a worldwide pandemic of epic proportion. Beyond pulmonary involvement in COVID-19, a significant subset of patients experiences acute kidney injury. Patients who die from severe disease most notably show diffuse acute tubular injury on postmortem examination with a possible contribution of focal macro- and microvascular thrombi. Renal biopsies in patients with proteinuria and hematuria have demonstrated a glomerular dominant pattern of injury, most notably a collapsing glomerulopathy reminiscent of findings seen in HIV in individuals with apolipoprotein L-1 (APOL-1) risk allele variants. Although various mechanisms have been proposed for the pathogenesis of acute kidney injury in SARS-CoV-2 infection, direct renal cell infection has not been definitively demonstrated and our understanding of the spectrum of renal involvement remains incomplete. Herein we discuss the biology, pathology and pathogenesis of SARS-CoV-2 infection and associated renal involvement. We discuss the molecular biology, risk factors and pathophysiology of renal injury associated with SARS-CoV-2 infection. We highlight the characteristics of specific renal pathologies based on native kidney biopsy and autopsy. Additionally, a brief discussion on ancillary studies and challenges in the diagnosis of SARS-CoV-2 is presented.