Kidney pathology in COVID-19 patients

   Coronaviruses are highly contagious and highly tropic to the kidney tissue. A new coronavirus infection can cause a wide range of pathological abnormalities of the kidneys, which is due to the content in the organs of angiotensin converting enzyme type 2 (ACE2), transmembrane serine protease 2 and cathepsin L, which are considered a target for SARS-CoV-2. Clinical manifestations vary from mild forms of acute respiratory viral infection to severe multiple organ lesions. Various clinical forms of kidney damage in COVID-19 are due to numerous pathogenetic mechanisms, such as the direct cytopathic effect of the virus on kidney structures, endothelial dysfunction, cytokine storm, hemodynamic and water metabolism disorders, and damage to the renin-angiotensin-aldosterone system. SARS-CoV-2 interacts with ACE2 receptors located on the endothelium of blood vessels, adversely affecting the microvascular bed. In addition, damage to the renal tissue is caused by the synthesis of pro-inflammatory interleukins, as well as hypovolemia and the accumulation of angiotensin II and bradykinin. Kidney damage in patients with COVID-19 includes such nosological forms as collapsing nephropathy, minimal change disease, membranous glomerulopathy, anti-GBM nephritis, acute tubular necrosis, exacerbation of autoimmune glomerulonephritis, allograft rejection. During clinical observations, scientists from different countries have established a relationship between confirmed COVID-19 and the following laboratory data: hematuria, proteinuria, elevated levels of blood urea nitrogen, serum creatinine, uric acid, D-dimer. Recent studies show that patients with coronavirus often suffer from kidney failure, which is closely associated with higher mortality and morbidity and is an indicator of survival in coronavirus infection. In addition, the presence of such risk factors in a patient as chronic kidney disease, cardiovascular pathology, the presence of immunodeficiency states, the use of nephrotoxic drugs, diabetes mellitus, hypertension, obesity, atherosclerosis, and advanced age complicate the course of infection and worsen the prognosis of the disease. Thus, the pathological effect of coronavirus on the body and on the kidneys, in particular, as well as high mortality among patients with renal pathology, determines the relevance of studying this problem and finding ways to solve it.

1. Valizadeh R. et al. Coronavirus-nephropathy; renal involvement in COVID-19 // J Renal Inj Prev. 2020; 2 (9): e18.

2. Werion A. et al. SARS-CoV-2 causes a specific dysfunction of the kidney proximal tubule // Kidney international. 2020; 5 (98): 1296-1307.

3. Li Z. et al. Caution on kidney dysfunctions of COVID-19 patients // MedRxiv. 2020.

4. Мустафин Р. Н. Вероятные механизмы патогенеза COVID-19 / Р. Н. Мустафин, Э. К. Хуснутдинова // Креативная хирургия и онкология. – 2020. – 4. URL: https://cyberleninka.ru/article/n/veroyatnye-mehanizmy-patogeneza-covid-19. [Mustafin R. N., Khusnutdinova E. K. Probable mechanisms of COVID-19 pathogenesis // Kreativnaya khirurgiya i onkologiya 2020; 4. URL: https://cyberleninka.ru/article/n/veroyatnye-mehanizmy-patogeneza-covid-19. ]

5. Грановская М. В. COVID-19 – набор симптомов или системная патология? Клиническая лекция. Часть 1. Особенности полиорганных нарушений / М. В. Грановская, К. Я. Заславская // Инфекционные болезни: Новости. Мнения. Обучение. – 2020. – S3 (34). URL: https://cyberleninka.ru/article/n/covid-19-nabor-simptomov-ili-sistemnaya-patologiya-klinicheskaya-lektsiya-chast-1-osobennosti-poliorgannyh-narusheniy. [Granovskaya M. V., Zaslavskaya K. Ya. Is COVID-19 a set of symptoms or a systemic pathology? Clinical lecture. Part 1. Features of multiple organ disorders // Infektsionnyye bolezni: Novosti. Mneniya. Obucheniye. 2020; S3 (34). URL: https://cyberleninka.ru/article/n/covid-19-nabor-simptomov-ili-sistemnaya-patologiya-klinicheskaya-lektsiya-chast-1-osobennosti-poliorgannyh-narusheniy. ]

6. Баклаушев В. П. COVID-19. Этиология, патогенез, диагностика и лечение / В. П. Баклаушев [и др.] // Клиническая практика. – 2020. – 1. URL: https://cyberleninka.ru/article/n/covid-19-etiologiya-patogenez-diagnostika-i-lechenie. [Baklaushev V. P., Kulemzin S. V., Gorchakov A. A., Yusubaliyeva G. M., Lesnyak V. N., Sotnikova A. G. COVID-19. Etiology, pathogenesis, diagnosis and treatment // Klinicheskaya praktika. 2020; 1. URL: https://cyberleninka.ru/article/n/covid-19-etiologiya-patogenez-diagnostika-i-lechenie. ]

7. Коган Е. А. Патологическая анатомия инфекции, вызванной SARS-CoV-2 / Е. А. Коган [и др.] // Судебная медицина. – 2020. – 2. URL: https://cyberleninka.ru/article/n/patologicheskaya-anatomiya-infektsii-vyzvannoy-sars-cov-2. [Kogan Ye. A., Berezovskiy Yu. S., Protsenko D. D., Bagdasaryan T. R., Gretsov Ye. M., Demura S. A., Demyashkin G. A., Kalinin D. V., Kukleva A. D., Kurilina E. V., Nekrasova T. P., Paramonova N. B., Ponomarev A. B., Radenska-Lopovok S. G., Semenova L. A., Tertychnyy A. S. Pathological anatomy of infection caused by SARS-CoV-2 // Sudebnaya meditsina. 2020; 2. URL: https://cyberleninka.ru/article/n/patologicheskaya-anatomiya-infektsii-vyzvannoy-sars-cov-2. ]

8. https://www.ncbi.nlm.nih.gov/gene/?term=59272.

9. Puelles V. G., Lütgehetmann M., Lindenmeyer M. T., Sperhake J. P., Wong M. N., Allweiss L., Chilla S., Heinemann A., Wanner N., Liu S., Braun F., Lu S., Pfefferle S., Schröder A. S., Edler C., Gross O., Glatzel M., Wichmann D., Wiech T., Kluge S., Pueschel K., Aepfelbacher M., Huber T. B. Multiorgan and Renal Tropism of SARS-CoV-2 // N Engl J Med. 2020; 383 (6): 590-592. DOI: 10.1056/NEJMc2011400. Epub 2020 May 13. PMID: 32402155; PMCID: PMC7240771.

10. Выхристенко Л. Р. Поражение почек при инфекции COVID-19 / Л. Р. Выхристенко [и др.] // Вестник ВГМУ. – 2021. – 1. URL: https://cyberleninka.ru/article/n/porazhenie-pochek-pri-infektsii-covid-19. [Vykhristenko L. R., Schastlivenko A. I., Bondareva L. I., Sidorenko Ye. V., Muzyka O. G. Kidney damage in COVID-19 infection // Vestnik VGMU. 2021; 1. URL: https://cyberleninka.ru/article/n/porazhenie-pochek-pri-infektsii-covid-19. ]

11. Кубанов А. А. Новый взгляд на патогенез COVID-19: заболевание является генерализованным васкулитом, а возникающее при этом поражение легочной ткани – вариантом ангиогенного отека легкого / А. А. Кубанов, Д. Г. Дерябин // Вестник РАМН. – 2020. – 2. URL: https://cyberleninka.ru/article/n/novyy-vzglyad-na-patogenez-covid-19-zabolevanie-yavlyaetsya-generalizovannym-virusnym-vaskulitom-a-voznikayuschee-pri-etom. [Kubanov A. A., Deryabin D. G. A new look at the pathogenesis of COVID-19: the disease is a generalized vasculitis, and the resulting damage to the lung tissue is a variant of angiogenic pulmonary edema // Vestnik RAMN. 2020; 2. URL: https://cyberleninka.ru/article/n/novyy-vzglyad-na-patogenez-covid-19-zabolevanie-yavlyaetsya-generalizovannym-virusnym-vaskulitom-a-voznikayuschee-pri-etom. ]

12. Varga Z., Flammer A. J., Steiger P., et al. Endothelial cell infection and endotheliitis in COVID-19 // Lancet. 2020; 395 (10234): 1417-1418. DOI: 10.1016/S0140-6736(20)30937-5.

13. Joannidis M., Forni L. G., Klein S. J., Honore P. M., Kashani K., Ostermann M., Prowle J., Bagshaw S. M., Cantaluppi V., Darmon M., Ding X., Fuhrmann V., Hoste E., Husain-Syed F., Lubnow M., Maggiorini M., Meersch M., Murray P. T., Ricci Z., Singbartl K., Staudinger T., Welte T., Ronco C., Kellum J. A. Lung-kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup // Intensive Care Med. 2020; 46 (4): 654-672. DOI: 10.1007/s00134-019-05869-7. Epub 2019 Dec 9. PMID: 31820034; PMCID: PMC7103017.

14. Ahmed A. R., Ebad C. A., Stoneman S., Satti M. M., Conlon P. J. Kidney injury in COVID-19 // World J Nephrol. 2020; 9 (2): 18-32. DOI: 10.5527/wjn.v9.i2.18. PMID: 33312899; PMCID: PMC7701935.

15. Panitchote A., Mehkri O., Hastings A., Hanane T., Demirjian S., Torbic H., Mireles-Cabodevila E., Krishnan S., Duggal A. Factors associated with acute kidney injury in acute respiratory distress syndrome // Ann Intensive Care. 2019; 9 (1): 74. DOI: 10.1186/s13613-019-0552-5. Erratum in: Ann Intensive Care. 2019 Jul 23; 9 (1): 84. PMID: 31264042; PMCID: PMC6603088.

16. Cheng Y. et al. Kidney disease is associated with in-hospital death of patients with COVID-19 // Kidney international. 2020; 5 (97): 829-838.

17. Wu C., Chen X., Cai Y., Xia J., Zhou X., Xu S., Huang H., Zhang L., Zhou X., Du C., Zhang Y., Song J., Wang S., Chao Y., Yang Z., Xu J., Zhou X., Chen D., Xiong W., Xu L., Zhou F., Jiang J., Bai C., Zheng J., Song Y. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China // JAMA Intern Med. 2020; 180 (7): 934-943. DOI: 10.1001/jamainternmed.2020.0994. Erratum in: JAMA Intern Med. 2020 Jul 1; 180 (7): 1031. PMID: 32167524.

18. Столяревич Е. С. Поражение почек при Covid-19: клинические и морфологические проявления почечной патологии у 220 пациентов, умерших от Covid-19 / Е. С. Столярович [и др.] // Нефрология и диализ. – 2020. – Т. 22. – Спецвыпуск. – С. 46. [Stolyarevich Ye. S. i dr. Kidney damage in Covid-19: clinical and morphological manifestations of renal pathology in 220 patients who died from Covid-19 // Nefrologiya i dializ. 2020. T. 22. Spetsvypusk. P. 46.]

19. Чеботарева Н. В. Частота, факторы риска и прогностическое значение острого повреждения почек у больных c COVID19: ретроспективное когортное исследование / Н. В. Чеботарева [и др.] // Клин. фармакол. тер. – 2021. – 30 (1): 30-35. [Chebotareva N. V., Berns S. A., Myasnikov A. L. i dr. Frequency, risk factors, and prognostic value of acute kidney injury in patients with COVID19: a retrospective cohort study // Klin. farmakol. ter. 2021; 30 (1): 30-35.]

20. Xia P. et al. Clinicopathological features and outcomes of acute kidney injury in critically ill COVID-19 with prolonged disease course: a retrospective cohort // Journal of the American Society of Nephrology. 2020; 9 (31): 2205-2221.

21. Kudose S. et al. Kidney biopsy findings in patients with COVID-19 // Journal of the American Society of Nephrology. 2020; 9 (31): 1959-1968.