Virus-Associated Nephropathies: A Narrative Review

Abstract

While most viral infections cause mild symptoms and a spontaneous favorable resolution, some can lead to severe or protracted manifestations, specifically in immunocompromised hosts. Kidney injuries related to viral infections may have multiple causes related to the infection severity, drug toxicity or direct or indirect viral-associated nephropathy. We review here the described virus-associated nephropathies in order to guide diagnosis strategies and treatments in cases of acute kidney injury (AKI) occurring concomitantly with a viral infection. The occurrence of virus-associated nephropathy depends on multiple factors: the local epidemiology of the virus, its ability to infect renal cells and the patient’s underlying immune response, which varies with the state of immunosuppression. Clear comprehension of pathophysiological mechanisms associated with a summary of described direct and indirect injuries should help physicians to diagnose and treat viral associated nephropathies.

Sophocarpine Alleviates Isoproterenol-Induced Kidney Injury by Suppressing Inflammation, Apoptosis, Oxidative Stress and Fibrosis

“…Kidney injury is a complex disease that is characterized by the impairment of renal function. It has been previously reported that a variety of pathogenic factors can lead to kidney injury, such as some drugs and a majority of toxics [14]. Moreover, sepsis has also been reported to serve as an important pathogenic factor that contributes to kidney injury [15].…”

The Human Virome and Its Crosslink with Glomerulonephritis and IgA Nephropathy

“…Interestingly, several studies have also shown the crucial role of infections in causing glomerulonephritis [ 59 ] and confirmed the main role of extrahepatic infection of the hepatitis B (HBV) and C (HCV) viruses [ 60 , 61 ] ( Table 1 ). Furthermore, other works highlighted the relationship between occult HCV/HBV infections and GN.…”

“…Patients may also have a protracted course of HBV-related mixed cryoglobulinemia (MC), often with severe renal manifestations involving nephrotic-range proteinuria and acute kidney disease (AKI) [ 59 ].…”

“…HBV-associated PAN leads to AKI as well as to heart attack. However, thanks to vaccination against HBV, both cases of NM associated with HBV in children and cases of HBV PAN have been reduced [ 59 ]. These observations allow us to reflect on the usefulness of vaccinations also to prevent less frequent virus-related diseases.…”

Severe dengue in the intensive care unit

“…[ 135 ] Although not yet fully understood, some mechanisms suggested as causes of AKI in severe dengue are hypotension – leading to hypoperfusion and tubular necrosis – direct injury caused by the virus, indirect injury via the immune system, and rhabdomyolysis. [ 136 , 137 ] Immunohistochemical studies performed on kidney specimens from fatal human cases of dengue infection found viral RNA and observed an accumulation of immune cells and intense acute congestion, suggesting that a combination of high viral load, exacerbated immune response, and increased permeability play a role in renal damage during dengue infection. [ 138 , 139 ]…”