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Review
. 2021 Nov;42(Suppl 1):76-80.
doi: 10.1007/s00292-020-00900-x. Epub 2021 Mar 1.

COVID-19 effects on the kidney

K Amann  1 , P Boor  2 , T Wiech  3 , J Singh  4 , E Vonbrunn  5 , A Knöll  6 , M Hermann  4 , M Büttner-Herold  5 , C Daniel  5 , A Hartmann  7
Affiliations
Review

COVID-19 effects on the kidney

K Amann et al. Pathologe. 2021 Nov.

Abstract
in English, German

Apart from pulmonary disease, acute kidney injury (AKI) is one of the most frequent and most severe organ complications in severe coronavirus disease 2019 (COVID-19). The SARS-CoV‑2 virus has been detected in renal tissue. Patients with chronic kidney disease (CKD) before and on dialysis and specifically renal transplant patients represent a particularly vulnerable population. The increasing number of COVID-19 infected patients with renal involvement led to an evolving interest in the analysis of its pathophysiology, morphology and modes of virus detection in the kidney. Meanwhile, there are ample data from several autopsy and kidney biopsy studies that differ in the quantity of cases as well as in their quality. While the detection of SARS-CoV‑2 RNA in the kidney leads to reproducible results, the use of electron microscopy for visualisation of the virus is difficult and currently critically discussed due to various artefacts. The exact contribution of indirect or direct effects on the kidney in COVID-19 are not yet known and are currently the focus of intensive research.

Bei einer schweren Coronavirus-Erkrankung-2019 (COVID-19) ist neben der Lungenerkrankung selbst das akute Nierenversagen (ANV) eine der häufigsten und schwerwiegendsten Komplikationen. Das SARS-CoV-2-Virus konnte hierbei auch in der Niere nachgewiesen werden. Patienten mit chronischen Nierenerkrankungen (CKD), dialysepflichtige sowie v. a. nierentransplantierte Patienten scheinen eine besonders vulnerable Population darzustellen. Die zunehmende Anzahl SARS-CoV-2-infizierter Patienten hat das Interesse an der genauen Pathophysiologie und Morphologie der Nierenschädigung sowie am direkten Virusnachweis in der Niere geweckt, der im Gegensatz zur Lunge insgesamt schwieriger zu führen ist. Hierzu liegen mittlerweile Daten aus Autopsie- und Nierenbiopsiestudien mit unterschiedlichen Patientenzahlen und von sehr unterschiedlicher Qualität vor. Während der Nachweis von SARS-CoV-2-RNA im Nierengewebe mit gut reproduzierbaren Ergebnissen erfolgt, ist insbesondere der Virusnachweis mittels Elektronenmikroskopie schwierig und wird aufgrund zahlreicher Artefakte derzeit kritisch diskutiert. Die genauen direkten oder indirekten Effekte von SARS-CoV‑2 auf die Niere sind noch nicht im Detail bekannt und derzeit der Fokus intensiver Forschung.

Keywords: Acute kidney injury; Coronavirus infections; Electron microscopy; Neutrophil extracellular traps (NETs); SARS-CoV‑2.

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Conflict of interest statement

K. Amann, P. Boor, T. Wiech, J. Singh, E. Vonbrunn, A. Knöll, M. Hermann, M. Büttner-Herold, C. Daniel and A. Hartmann declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
SARS-CoV‑2 virus detection in kidney and characteristic glomerular changes. a SARS-CoV‑2 virus detection in the kidney. Fluorescence in situ hybridization (FISH) shows RNA expression of SARS-CoV‑2 virus (green; arrows) and its receptor angiotensin-converting enzyme 2 (ACE2; red) in the glomerulus of the kidney of a COVID-19 patient. Scale bar = 20 µm (from [36]). b Renal histology of a 38-year-old patient with COVID-19 and acute renal failure. Left: Masson–Goldner staining shows fresh, wall-bound fibrin thrombi (orange) in the glomerular capillaries. Right: Immunohistochemistry for fibrinogen/fibrin shows wall-adherent precipitates (red) in numerous glomerular capillaries
See this image and copyright information in PMC

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