Renal Morphology in Coronavirus Disease: A Literature Review

Abstract

Renal biopsy is useful to better understand the histological pattern of a lesion (glomerular, tubulointerstitial, and vascular) and the pathogenesis that leads to kidney failure. The potential impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the kidneys is still undetermined, and a variety of lesions are seen in the kidney tissue of coronavirus disease patients. This review is based on the morphological findings of patients described in case reports and a series of published cases. A search was conducted on MEDLINE and PubMed of case reports and case series of lesions in the presence of non-critical infection by SARS-CoV-2 published until 15/09/2020. We highlight the potential of the virus directly influencing the damage or the innate and adaptive immune response activating cytokine and procoagulant cascades, in addition to the genetic component triggering glomerular diseases, mainly collapsing focal segmental glomerulosclerosis, tubulointerstitial, and even vascular diseases. Kidney lesions caused by SARS-CoV-2 are frequent and have an impact on morbidity and mortality; thus, studies are needed to assess the morphological kidney changes and their mechanisms and may help define their spectrum and immediate or long-term impact.

The overall impact of COVID‐19 on healthcare during the pandemic: A multidisciplinary point of view

“…The direct influence of the SARS‐Cov2 in the renal damage or the innate and adaptive immune response activating cytokine and procoagulant cascades have been found to trigger glomerular diseases, principally collapsing focal segmental glomerulosclerosis, tubulointerstitial, and vascular diseases. 46 , 47 (Figure 1 ).…”

Collapsing glomerulopathy following SARS-CoV-2 adenovirus-vector–based vaccine: report of 2 cases

“…In the setting of the rapid spread of the pandemic by the new coronavirus (COVID-19) and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the kidney was recognized as a frequent target. 1 With the beginning of vaccination for COVID-19, several cases of post-vaccination immunological manifestations have been described. 2 We report herein the first two cases of patients who developed biopsy-proven CG after SARS-CoV-2 adenovirus-vector based vaccination.…”

Collapsing Glomerulopathy: A Review by the Collapsing Brazilian Consortium

“…APOL1 mutations have been detected in many patients with COVID-19, which suggested that the virus is a potential secondary trigger for glomerular damage (45). In fact, studies have confirmed the strong association of CG and non-collapsing podocytopathies with concurrent or recent COVID-19 in patients with APOL1 high-risk alleles (44)(45)(46).…”

“…The association between SARS-CoV-2 infection and CG was initially demonstrated in a series of autopsies ( 7 ). A recent systematic review of 59 studies reporting COVID-19 related histopathological diagnoses from kidney biopsy identified CG as the most common finding, followed by acute tubular injury and trombotic microangiopathy ( 44 ). Various mechanisms of AKI secondary to COVID-19 have been proposed—from direct intrarenal infection to dysregulation of the renin-angiotensin-aldosterone system, to altered hemodynamic control, coagulation and cytokine homeostasis ( 44 ).…”

“…A recent systematic review of 59 studies reporting COVID-19 related histopathological diagnoses from kidney biopsy identified CG as the most common finding, followed by acute tubular injury and trombotic microangiopathy ( 44 ). Various mechanisms of AKI secondary to COVID-19 have been proposed—from direct intrarenal infection to dysregulation of the renin-angiotensin-aldosterone system, to altered hemodynamic control, coagulation and cytokine homeostasis ( 44 ). Although the association is multifactorial, it has been emphasized the influence of the hyperactive inflammatory process and participation of circulating interferons ( 44 ) and direct infection appears highly unlikely to play a significant pathogenic role.…”