Pathophysiology and Pathology of Acute Kidney Injury in Patients With COVID-19

Jia H Ng; Vanesa Bijol; Matthew A Sparks; Meghan E Sise; Hassane Izzedine; Kenar D Jhaveri

doi:10.1053/j.ackd.2020.09.003

Pathophysiology and Pathology of Acute Kidney Injury in Patients With COVID-19

Adv Chronic Kidney Dis. 2020 Sep;27(5):365-376. doi: 10.1053/j.ackd.2020.09.003. Epub 2020 Oct 20.

Authors

Jia H Ng¹, Vanesa Bijol², Matthew A Sparks³, Meghan E Sise⁴, Hassane Izzedine⁵, Kenar D Jhaveri⁶

Affiliations

¹ Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY. Electronic address: [email protected].
² Department of Pathology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY.
³ Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC; Renal Section, Durham Veterans Affairs Health Care System, Durham, NC.
⁴ Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
⁵ Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, Paris, France.
⁶ Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY.

Abstract

Acute kidney injury (AKI) is common among hospitalized patients with Coronavirus Infectious Disease 2019 (COVID-19), with the occurrence of AKI ranging from 0.5% to 80%. The variability in the occurrence of AKI has been attributed to the difference in geographic locations, race/ethnicity, and severity of illness. AKI among hospitalized patients is associated with increased length of stay and in-hospital deaths. Even patients with AKI who survive to hospital discharge are at risk of developing chronic kidney disease or end-stage kidney disease. An improved knowledge of the pathophysiology of AKI in COVID-19 is crucial to mitigate and manage AKI and to improve the survival of patients who developed AKI during COVID-19. The goal of this article is to provide our current understanding of the etiology and the pathophysiology of AKI in the setting of COVID-19.

Keywords: AKI; COVID-19; Collapsing GN; Kidney failure; Pathology.

Publication types

Research Support, N.I.H., Extramural
Review

MeSH terms

Acute Kidney Injury / etiology
Acute Kidney Injury / metabolism*
Acute Kidney Injury / pathology
Acute Kidney Injury / physiopathology
Anti-Bacterial Agents / adverse effects
Antiviral Agents / adverse effects
Apolipoprotein L1 / genetics
Ascorbic Acid / adverse effects
Azotemia / metabolism
Azotemia / pathology
Azotemia / physiopathology
COVID-19 / metabolism*
COVID-19 / pathology
COVID-19 / physiopathology
COVID-19 Drug Treatment
Cytokines / metabolism*
Disease Progression
Glomerulonephritis / metabolism*
Glomerulonephritis / pathology
Glomerulonephritis / physiopathology
Glomerulonephritis, Membranous / metabolism
Glomerulonephritis, Membranous / pathology
Glomerulonephritis, Membranous / physiopathology
Hospital Mortality
Humans
Kidney Tubules, Proximal / injuries
Length of Stay
Myoglobin / metabolism
Nephritis, Interstitial / metabolism
Nephritis, Interstitial / pathology
Nephritis, Interstitial / physiopathology
Nephrosis, Lipoid / metabolism
Nephrosis, Lipoid / pathology
Nephrosis, Lipoid / physiopathology
Renal Insufficiency, Chronic
Rhabdomyolysis / metabolism
SARS-CoV-2
Severity of Illness Index
Thrombotic Microangiopathies / metabolism*
Thrombotic Microangiopathies / pathology
Thrombotic Microangiopathies / physiopathology
Vitamins / adverse effects

Substances

Anti-Bacterial Agents
Antiviral Agents
Apolipoprotein L1
Cytokines
Myoglobin
Vitamins
Ascorbic Acid

Grants and funding

K23 DK117014/DK/NIDDK NIH HHS/United States