What is the role of COVID-19 in the etiology of acute kidney injury (AKI)?

Updated: Dec 24, 2020
  • Author: Biruh T Workeneh, MD, PhD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Kidney involvement is frequent in patients with severe COVID-19. More than 40% of patients have abnormal proteinuria on hospital admission, and  approximately 20–40% of patients admitted to intensive care units in Europe and the USA have AKI. [10] In patients with COVID-19, severe AKI is an ominous development that is associated with high mortality. [11]

AKI in COVID-19 is probably multifactorial, and may have a distinct pathophysiology that includes the following [12, 13] :

  • Hypotension and decreased kidney perfusion secondary to hemodynamic or hemostatic factors or associated sepsis
  • Endothelial dysfunction, with hypercoagulability, and complement activation
  • Nephrotoxins (medications, contrast agents)
  • Organ crosstalk among the injured lungs, heart, and kidney
  • Direct infection of kidney tubules with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that induces cytoplasmic renal tubular inclusions

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