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.

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