Acute kidney injury and COVID-19

Abstract

The SARS-CoV-2 virus has disrupted an entire planet creating a pandemic that has led to 1.3 million global deaths in a 10-month period. It is a spiked virus that attaches to an ACE2 receptor on lung and respiratory cells. In addition to damage caused by the virus, ACE2 receptor binding causes an increase in angiotensin 2, which also can damage cells. Targeting respiratory cells can result in acute respiratory distress syndrome, requiring assisted ventilation. This population of critically ill patients frequently develops acute kidney injury. Patients with chronic kidney disease are more susceptible to having bad outcomes from COVID-19. African Americans with two APOL1 gene variants are at risk to develop collapsing glomerulopathy as the consequence of increased interferon production by viral infected cells. Transplant patients are also more likely to have poor outcomes from COVID-19. Although transplantation was halted for a brief time early in the pandemic, the number of kidney transplants performed in 2020 is similar to 2019. Vaccines were developed and implemented against the SARS-CoV-2 virus. However, mutations threaten at least blunted resistance to the vaccines unless boosters can be developed. It is not clear whether effective neutralizing antibody responses to the currently available SARS-CoV-2 vaccines will fully develop and protect patients with advanced kidney disease and transplant populations, and until this question is answered, CKD and transplant patients should remain vigilant with respect to wearing masks and social distancing.