Ahmed AR, Ebad CA, Stoneman S, Satti MM, Conlon PJ. Kidney injury in COVID-19. World J Nephrol 2020; 9(2): 18-32 [PMID: 33312899 DOI: 10.5527/wjn.v9.i2.18]
Corresponding Author of This Article
Adeel Rafi Ahmed, MBChB, MRCP, Staff Physician, Department of Nephrology, Beaumont Hospital, Dublin 9, Dublin D09 V2N0, Ireland. adeel.r.ahmed@gmail.com
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Adeel Rafi Ahmed, Chaudhry Adeel Ebad, Sinead Stoneman, Department of Nephrology, Beaumont Hospital, Dublin D09 V2N0, Ireland
Muniza Manshad Satti, Department of Medicine, Connolly Hospital, Dublin D15X40D, Ireland
Peter J Conlon, Department of Nephrology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin D09 V2N0, Ireland
Author contributions: Ahmed AR conceived and designed the study, performed literature review and analysis, drafted and critically revised and edited the manuscript and approved the final version; Ebad CA contributed to the section on management of renal transplant recipients in coronavirus disease 2019, final editing and critical analysis of the article; Stoneman S contributed to the section on direct viral invasion of renal parenchyma, final editing and critical analysis of the article; Satti MM contributed to the literature review for the pathophysiology of acute kidney injury in acute respiratory distress syndrome, final editing and critical analysis; Conlon PJ contributed and supervised with conception and design of the study, literature review and analysis, drafting and critical revision and editing and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Received: June 25, 2020 Peer-review started: June 25, 2020 First decision: August 22, 2020 Revised: October 3, 2020 Accepted: October 20, 2020 Article in press: October 20, 2020 Published online: November 29, 2020 Processing time: 152 Days and 16.3 Hours
Abstract
Coronavirus disease 2019 (COVID-19) continues to affect millions of people around the globe. As data emerge, it is becoming more evident that extrapulmonary organ involvement, particularly the kidneys, highly influence mortality. The incidence of acute kidney injury has been estimated to be 30% in COVID-19 non-survivors. Current evidence suggests four broad mechanisms of renal injury: Hypovolaemia, acute respiratory distress syndrome related, cytokine storm and direct viral invasion as seen on renal autopsy findings. We look to critically assess the epidemiology, pathophysiology and management of kidney injury in COVID-19.
Core Tip: Kidney injury in coronavirus disease 2019 (COVID-19) is associated with increased mortality with hypovolaemia, acute respiratory distress syndrome (ARDS), cytokine storm and direct viral invasion having a prominent pathophysiological role. Haematuria and proteinuria are present in a high proportion of cases reflecting possible glomerular involvement, and collapsing glomerulopathy has also been reported in genetically predisposed patients. This is further supported by autopsy findings showing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in proximal tubules and podocytes. Evidence supports a conservative fluid management strategy in COVID-19 associated ARDS with standard indications for renal replacement therapy. Hypercoagulation is a prominent feature leading to filter clotting, thus regional citrate anticoagulation should be used. Kidney transplant recipients with COVID-19 should have immunosuppression reduced.
