CLINICAL FINDINGS & TREATMENT
Nearly 30% of patients hospitalized with COVID-19 and 50% of critically ill patients are affected by AKI, which is associated with poorer prognosis. Many causes of AKI are described in patients with COVID-19, but the most common is ATN related to a high inflammatory state (termed “cytokine storm”) and to states of prolonged hypotension and volume depletion.
UA may reveal hematuria, reflecting endothelial injury and fibrin thrombi that are commonly observed on biopsy. An emerging entity is COVID-19–associated collapsing glomerulopathy, which is a type of focal segmental glomerulosclerosis that predominantly affects Black patients, due to the increased prevalence of high-risk APOL1 genetic variants (see section on Nephrotic Spectrum Glomerular Diseases below). Collapsing glomerulopathy presents with nephrotic syndrome. Treatment of COVID-19–related AKI is largely supportive; approximately 20% of patients require kidney replacement therapy. Corticosteroids have been used in COVID-19–associated collapsing glomerulopathy with reported success, but there is a lack of trial data or long-term follow-up to date to confirm efficacy.
et al. Longitudinal outcomes of COVID-19-associated collapsing glomerulopathy and other podocytopathies. J Am Soc Nephrol. 2021;32:2958.
et al. A multi-center retrospective cohort study defines the spectrum of kidney pathology in Coronavirus 2019 Disease (COVID-19). Kidney Int. 2021;100:1303.
et al. Outcomes among patients hospitalized with COVID-19 and acute kidney injury. Am J Kidney Dis. 2021;77:204.
PM. COVID-19 and AKI: where do we stand? J Am Soc Nephrol. 2021;32;1029.
et al. Management of acute kidney injury in patients with COVID-19. Lancet Respir Med. 2020;8:738.