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Review
. 2023 Aug;23(4):1003-1014.
doi: 10.1007/s10238-022-00941-x. Epub 2022 Nov 18.

Acute and chronic histopathological findings in renal biopsies in COVID-19

Meint Volbeda #  1 , Daniela Jou-Valencia  2 , Marius C van den Heuvel  3 , Jan G Zijlstra  2 , Casper F M Franssen  4 , Peter H J van der Voort  2 , Jill Moser  2   5 , Matijs van Meurs  2   5
Affiliations
Review

Acute and chronic histopathological findings in renal biopsies in COVID-19

Meint Volbeda et al. Clin Exp Med. 2023 Aug.

Abstract

The dominant ICU admission diagnosis of COVID-19 patients is respiratory insufficiency, but 32-57% of hospitalized COVID-19 patients develop acute kidney injury (COVID-AKI). The renal histopathological changes accompanying COVID-AKI are not yet fully described. To obtain a detailed insight into renal histopathological features of COVID-19, we conducted a review including all studies reporting histopathological findings of diagnostic and postmortem kidney biopsies from patients with COVID-19 published between January 1, 2020, and January 31, 2021. A total of 89 diagnostic and 194 postmortem renal biopsies from individual patients in 39 published studies were investigated and were included in the analysis. In the diagnostic biopsy group, mean age was 56 years and AKI incidence was 96%. In the postmortem biopsy group, mean age was 69 years and AKI incidence was 80%. In the diagnostic biopsy group, the prevalence of acute glomerular diseases was 74%. The most common glomerular lesions were collapsing focal segmental glomerulosclerosis (c-FSGS) in 54% and thrombotic microangiopathy (TMA) in 9% of patients. TMA was also found in 10% of patients in the postmortem biopsy group. The most common acute tubular lesions was acute tubular necrosis (ATN) which was present in 87% of patients in the diagnostic and in 77% of patients in the postmortem biopsy group. Additionally, we observed a high prevalence of preexisting chronic lesions in both groups such as atherosclerosis and glomerulosclerosis. Histopathological changes in renal biopsies of COVID-19 patients show a heterogeneous picture with acute glomerular lesions, predominantly c-FSGS and TMA, and acute tubular lesions, predominantly ATN. In many patients, these lesions were present on a background of chronic renal injury.

Keywords: Acute kidney injury; COVID-19; Histopathology; Postmortem; Renal biopsy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram study selection
Fig. 2
Fig. 2
Major acute and chronic renal histopathology findings associated with COVID-19
Fig. 3
Fig. 3
Prevalence of KDIGO AKI stages in patients in the postmortem biopsy group with ATN on renal biopsy
See this image and copyright information in PMC

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