Pathophysiology and Clinical Manifestations of COVID-19-Related Acute Kidney Injury-The Current State of Knowledge and Future Perspectives

Int J Mol Sci. 2021 Jun 30;22(13):7082. doi: 10.3390/ijms22137082.

Abstract

The continually evolving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in a vast number of either acute or chronic medical impairments of a pathophysiology that is not yet fully understood. SARS-CoV-2 tropism for the organs is associated with bilateral organ cross-talks as well as targeted dysfunctions, among which acute kidney injury (AKI) seems to be highly prevalent in infected patients. The need for efficient management of COVID-related AKI patients is an aspect that is still being investigated by nephrologists; however, another reason for concern is a disturbingly high proportion of various types of kidney dysfunctions in patients who have recovered from COVID-19. Even though the clinical picture of AKI and COVID-related AKI seems to be quite similar, it must be considered that regarding the latter, little is known about both the optimal management and long-term consequences. These discrepancies raise an urgent need for further research aimed at evaluating the molecular mechanisms associated with SARS-CoV-2-induced kidney damage as well as standardized management of COVID-related AKI patients. The following review presents a comprehensive and most-recent insight into the pathophysiology, clinical manifestations, recommended patient management, treatment strategies, and post-mortem findings in patients with COVID-related AKI.

Keywords: AKI; COVID-19; SARS-CoV-2; SARS-CoV-2 tropism; acute kidney injury; coronavirus; glomerulopathy; survival rate.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / etiology
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Biomarkers / metabolism
  • COVID-19 / complications
  • COVID-19 / pathology*
  • COVID-19 / virology
  • COVID-19 Drug Treatment
  • Glomerular Filtration Rate
  • Humans
  • Interleukin-6 / metabolism
  • Renin-Angiotensin System
  • Rhabdomyolysis / etiology
  • SARS-CoV-2 / isolation & purification

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Biomarkers
  • Interleukin-6