The relationship between chikungunya virus and the kidneys: A scoping review

Abstract

Several atypical forms of chikungunya fever (CHIK) have been described, including neurological, cardiac and renal involvement. These forms may be related to high morbidity and mortality rates. This scoping review based on the PubMed, Scopus, and WOS databases aims to identify and summarise all the available evidence regarding the clinical and histopathological presentations and risk factors associated with kidney injury related to CHIK, as well as the clinical impact. Thus, a total of 54 papers were selected from 1606 initial references after applying the defined inclusion criteria. Data on the association between kidney injury and CHIK are scarce, with studies only conducted in the acute phase of the disease, lacking further characterisation. Kidney injury incidence in hospitalised patients using the Kidney Disease Improving Global Outcomes criteria varies from 21% to 45%, being higher among patients with atypical and severe manifestations. Although acute kidney injury does not seem to be related to viraemia, it may be related to higher mortality.Few studies have described the renal histopathological changes in the acute phase of CHIK, with prevalent findings of acute interstitial nephritis with mononuclear infiltrate, glomerular congestion and nephrosclerosis. Only one study assessed the kidney function of patients in the subacute and chronic phases of CHIK. Additionally, individuals with comorbidities, including chronic kidney disease, may be among those with a greater risk of presenting worse outcomes when affected by CHIK. The results described herein may contribute to better understand the relationship between the kidneys and chikungunya virus.

Common arboviruses and the kidney: a review

“…Kidney disease in chikungunya ranges from 21 to 45% 23 . Severe cases of chikungunya can lead to acute kidney injury (AKI) in a frequency as high as 79%, and are associated with higher mortality 23 . One case report described a male patient with fever, myalgia, and anuria 25 .…”

“…Immunological mechanisms are involved in the process of CHIKV kidney disease. There is an imbalance in the immune response with evidence of IgM-type antibody production and the formation of autoantibodies, including cryoglobulins, which have kidney-damaging properties 23 . The virus can escape the immune system, and there may also be an interaction between genes and the environment that determines each patient’s response to the infection 23 .…”

“…There is an imbalance in the immune response with evidence of IgM-type antibody production and the formation of autoantibodies, including cryoglobulins, which have kidney-damaging properties 23 . The virus can escape the immune system, and there may also be an interaction between genes and the environment that determines each patient’s response to the infection 23 . Kidney tissue could also serve as a CHIKV reservoir, as this virus has the ability to persist in various organs and tissues 23 .…”

Extra-articular Manifestations of Chikungunya

“…Renal complications have been reported in 21%-45% of CHIK cases and are more common among severely ill patients. Most of these patients have renal comorbidities, particularly chronic kidney disease, which contributes to high mortality rate 31 . It is still unknown whether the kidneys serve as reservoirs of the virus 32 .…”

“…Acute interstitial nephritis and tubular injury were the most common renal findings 3,31 . Nephrosclerosis, membranoproliferative glomerulonephritis, and epithelioid granulomas have been less frequently reported.…”