The Hypothesis of the COVID-19 Role in Acute kidney Injury: A Literatures Review

Document Type : Review


Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran



Coronavirus disease 2019 (COVID-2019) is a viral infection that mainly causes pulmonary infection but mortality usually occurred in patients have comorbidity, such as chronic kidney disease (CKD) that accounts for over 20% of mortalities, morbid obesity, immunosuppression, diabetes mellitus, hypertension, and cancer. Also, the incidence of acute kidney failure reported 5-10% in outpatient series and up to 50% in patients that need to be admitted in the intensive care unit. It is important to know that acute kidney injury (AKI) is associated with increased mortality, so this essay is going to review possible mechanisms that result in AKI. Based on the multifactorial mechanism of AKI, we should have considered probable causes of AKI and act on a stepwise manner to tackle these mechanisms and improve the ultimate prognosis of patients. Although most of the measures are supportive, in some patients such as severely ill cases cytokine storm may be attributed to the severity of symptoms, so immunomodulatory treatments could be considered to decrease AKI and consequently mortality. Among hypotheses that propose AKI; pre-renal and direct renal involvement by virus discussed in detail.


  • Patients with COVID-19 contamination might have acute kidney injury.
  • Death is significantly higher among patients with acute renal failure.
  • The main risk factors for acute kidney injury are male sex, diabetes mellitus hypertension,cardiovascular disease.


1. Ji W, Wang W, Zhao X, Zai J, Li X. Cross‐species transmission of the newly identified coronavirus 2019 nCoV. Journal of medical virology. 2020;92(4):433-40.
2. Corman V, Lienau J, Witzenrath M. Coronaviruses as the cause of respiratory infections. Der Internist. 2019;60(11):1136-45.
3. Perico L, Benigni A, Remuzzi G. Should COVID-19 concern nephrologists? Why and to what extent? The emerging impasse of angiotensin blockade. Nephron. 2020;144(5):213-21.
4. (WHO) WHO. Coronavirus disease (COVID-19) pandemic 2020 [Available from:
5. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020.
6. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney international. 2020.
7. Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal involvement and early prognosis in patients with COVID-19 pneumonia. Journal of the American Society of Nephrology. 2020;31(6):1157-65.
8. Yamada T, Mikami T, Chopra N, Miyashita H, Chernyavsky S, Miyashita S. Patients with chronic kidney disease have a poorer prognosis of coronavirus disease 2019 (COVID-19): an experience in New York City. International Urology and Nephrology. 2020:1.
9. Wang L, Li X, Chen H, Yan S, Li D, Li Y, et al. Coronavirus disease 19 infection does not result in acute kidney injury: an analysis of 116 hospitalized patients from Wuhan, China. American journal of nephrology. 2020;51(5):343-8.
10. Su H, Yang M, Wan C, Yi L-X, Tang F, Zhu H-Y, et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney international. 2020.
11. Rossi GM, Delsante M, Pilato FP, Gnetti L, Gabrielli L, Rossini G, et al. Kidney biopsy findings in a critically ill COVID-19 patient with dialysis-dependent acute kidney injury: a case against “SARS-CoV-2 nephropathy”. Kidney International Reports. 2020;5(7):1100-5.
12. Diao B, Feng Z, Wang C, Wang H, Liu L, Wang C, et al. Human kidney is a target for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. MedRxiv. 2020.
13. Meng X-M, Nikolic-Paterson DJ, Lan HY. Inflammatory processes in renal fibrosis. Nature Reviews Nephrology. 2014;10(9):493-503.
14. Goldsmith CS, Miller SE. Caution in identifying coronaviruses by electron microscopy. Journal of the American Society of Nephrology. 2020.
15. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. Jama. 2020.
16. Covid C, COVID C, COVID C, Chow N, Fleming-Dutra K, Gierke R, et al. Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019—United States, February 12–March 28, 2020. Morbidity and Mortality Weekly Report. 2020;69(13):382.
17. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. Jama. 2020;323(13):1239-42.
18. Novel CPERE. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua liu xing bing xue za zhi= Zhonghua liuxingbingxue zazhi. 2020;41(2):145.
19. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020;395(10223):497-506.
20. Iaccarino G, Grassi G, Borghi C, Ferri C, Salvetti M, Volpe M. Age and multimorbidity predict death among COVID-19 patients: results of the SARS-RAS study of the Italian Society of hypertension. Hypertension. 2020;76(2):366-72.
21. Qi F, Qian S, Zhang S, Zhang Z. Single cell RNA sequencing of 13 human tissues identify cell types and receptors of human coronaviruses. Biochemical and biophysical research communications. 2020.
22. Batlle D, Soler MJ, Sparks MA, Hiremath S, South AM, Welling PA, et al. Acute kidney injury in COVID-19: emerging evidence of a distinct pathophysiology. Journal of the American Society of Nephrology. 2020.
23. Nalesso F, Garzotto F, Cattarin L, Gobbi L, Qassim L, Sgarabotto L, et al. A Continuous Renal Replacement Therapy Protocol for Patients with Acute Kidney Injury in Intensive Care Unit with COVID-19. Journal of Clinical Medicine. 2020;9(5):1529.