COVID-19 impact on the renal system: pathophysiology and clinical outcomes

Kaye, Alan D.; Okeagu, Chikezie N.; Tortorich, Gregory; Pham, Alex D.; Ly, Eric I.; Brondeel, Kimberley C.; Eng, Matthew R.; Luedi, Markus M.; Urman, Richard D.; Cornett, Elyse M.

COVID-19 has numerous deleterious effects throughout the body. Prior studies had shown that the incidence of acute kidney injury in COVID-19 patients could be as high as 25%. There are also autopsy reports showing evidence of viral tropism to the renal system. In this regard, COVID-19 can damage the kidneys and increase a patient's risk of requiring dialysis. Available evidence suggests that renal involvement in COVID-19 infection is not uncommon, and there has been an increased incidence of chronic kidney disease related to the pandemic. In this present review, we address COVID-19 and its effects on the renal system, including the pathophysiologic mechanisms. We also address current studies on the causes of injury to the renal system, the cause of kidney failure, its effect on mortality, the impact on dialysis patients, and the impact on renal transplant patients. COVID-19 disease may have unique features in individuals on chronic dialysis and kidney transplant recipients, requiring increased vigilance in limiting viral transmission in perioperative, in-patient, and dialysis center settings.