Renal Considerations in COVID-19: Biology, Pathology, and Pathophysiology

Meghan E. Kapp, Agnes B. Fogo, Candice Roufouse, Behzad Najafian, Jai Radhakrishnan, Sumit Mohan, Sara E. Miller, Vivette D. D'Agati, Jeffrey Silberzweig, Tarek Barbar, Tulasi Gopalan, Vesh Srivatana, Michele H. Mokrzycki, Judith A. Benstein, Yue Harn Ng, Krista L. Lentine, Vikram Aggarwal, Jeffrey Perl, Page Salenger, Jay L. KoynerMichelle A. Josephson, Michael Heung, Juan Carlos Velez, Alp Ikizler, Anitha Vijayan, Preethi William, Bijin Thajudeen, Marvin J. Slepian

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has emerged into a worldwide pandemic of epic proportion. Beyond pulmonary involvement in coronavirus disease 2019 (COVID-19), a significant subset of patients experiences acute kidney injury. Patients who die from severe disease most notably show diffuse acute tubular injury on postmortem examination with a possible contribution of focal macro- and microvascular thrombi. Renal biopsies in patients with proteinuria and hematuria have demonstrated a glomerular dominant pattern of injury, most notably a collapsing glomerulopathy reminiscent of findings seen in human immunodeficiency virus (HIV) in individuals with apolipoprotein L-1 (APOL1) risk allele variants. Although various mechanisms have been proposed for the pathogenesis of acute kidney injury in SARS-CoV-2 infection, direct renal cell infection has not been definitively demonstrated and our understanding of the spectrum of renal involvement remains incomplete. Herein we discuss the biology, pathology, and pathogenesis of SARS-CoV-2 infection and associated renal involvement. We discuss the molecular biology, risk factors, and pathophysiology of renal injury associated with SARS-CoV-2 infection. We highlight the characteristics of specific renal pathologies based on native kidney biopsy and autopsy. Additionally, a brief discussion on ancillary studies and challenges in the diagnosis of SARS-CoV-2 is presented.

Original languageEnglish
Pages (from-to)1087-1096
Number of pages10
JournalASAIO Journal
Issue number10
StatePublished - Oct 1 2021


  • COVID-19
  • acute kidney injury
  • acute tubular injury
  • biology
  • glomerular disease
  • pathology
  • pathophysiology


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