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Life
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COVID-19 and Kidney Disease
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COVID-19 and Kidney Disease

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 12412

Special Issue Editor

Dr. Gaetano Alfano

E-Mail Website
Guest Editor
Nephrology Dialysis and Transplant Unit, University Hospital of Modena, 41124 Modena, Italy
Interests: CKD; dialysis; COVID-19; kidney transplantation; HIV; anemia

Special Issue Information

Dear Colleagues,

SARS-CoV-2 infection has been one of the most challenging events in human history. This illness spread quickly worldwide as a pandemic causing a significant loss of life, sharp decrease in economic output, and profound re-organizing of healthcare services and practice for patients requiring assistance. COVID-19 has disproportionately affected patients with chronic kidney disease (CKD) and has, directly and indirectly, led to kidney dysfunction in patients with normal renal function prior to COVID-19. The information collected after more than three years after the start of COVID-19 shows that the rate of severe COVID-19 has been high in patients with chronic kidney disease (CKD), including dialysis patients and kidney transplant recipients. This latter group of patients experienced a high rate of mortality and mortality before the advent of SARS-CoV-2 vaccination. Acute kidney injury (AKI) has been another complication of COVID-19 with marked variability in its reported incidence and outcomes. Large observational studies and meta-analyses report that one-third of all inpatients and more than half of patients admitted to intensive care units developed an abrupt deterioration in kidney function.

The advent of vaccination has substantially mitigated COVID-19 symptoms and COVID-19-related kidney complications. However, many questions remained unanswered in this field including the role of dysregulation of the renin–angiotensin–aldosterone system (RAAS), development of COVID-19- and SARS-CoV-2 vaccination-associated glomerulonephritis, management of COVID-19 symptoms and prevention of severe COVID-19 complications in patients with kidney disease. In light of this interplay between COVID-19 and the kidney, this Special Issue aims to furnish an overview of the SARS-CoV-2 pathogenesis with a focus on kidney disease.

Dr. Gaetano Alfano
Guest Editor

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Keywords

  • renin angiotensin system
  • CKD
  • dialysis
  • kidney transplantation
  • COVID-19-associated glomerular disease
  • therapy

Published Papers (9 papers)

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Research

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12 pages, 654 KiB  
Article
Impact of Acute Kidney Injury on the COVID-19 In-Hospital Mortality in Octogenarian Patients: Insights from the COVOCA Study
by Alfredo Caturano, Raffaele Galiero, Erica Vetrano, Giulia Medicamento, Maria Alfano, Domenico Beccia, Chiara Brin, Sara Colantuoni, Jessica Di Salvo, Raffaella Epifani, Riccardo Nevola, Raffaele Marfella, Celestino Sardu, Carmine Coppola, Ferdinando Scarano, Paolo Maggi, Cecilia Calabrese, Pellegrino De Lucia Sposito, Carolina Rescigno, Costanza Sbreglia, Fiorentino Fraganza, Roberto Parrella, Annamaria Romano, Giosuele Calabria, Benedetto Polverino, Antonio Pagano, Fabio Giuliano Numis, Carolina Bologna, Mariagrazia Nunziata, Vincenzo Esposito, Nicola Coppola, Nicola Maturo, Rodolfo Nasti, Pierpaolo Di Micco, Alessandro Perrella, Luigi Elio Adinolfi, Marina Di Domenico, Marcellino Monda, Vincenzo Russo, Roberto Ruggiero, Giovanni Docimo, Luca Rinaldi and Ferdinando Carlo Sassoadd Show full author list remove Hide full author list
Life 2024, 14(1), 86; https://doi.org/10.3390/life14010086 - 4 Jan 2024
Viewed by 1179
Abstract
Background and Aims: The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has fundamentally reshaped the landscape of global public health, with some people suffering more adverse clinical outcomes than others. The aim of this study is to deepen our understanding of the [...] Read more.
Background and Aims: The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has fundamentally reshaped the landscape of global public health, with some people suffering more adverse clinical outcomes than others. The aim of this study is to deepen our understanding of the specific impact of acute kidney injury (AKI) on the in-hospital mortality in octogenarian patients with COVID-19. Methods: This is a prospective observational cohort study, which involved 23 COVID-19 hospital units in the Campania Region, Italy. Exposure variables were collected during hospital admission and at discharge. Only patients aged ≥80 years were deemed eligible for the study. Results: 197 patients were included in the study (median age 83.0 [82.0–87.0] years; 51.5% men), with a median duration of hospitalization of 15.0 [8.0–25.0] days. From the multivariable Cox regression analysis, after the application of Šidák correction, only the respiratory rate (HR 1.09, 95% CI: 1.04 to 1.14; p < 0.001) and AKI development (HR: 3.40, 95% CI: 1.80 to 6.40; p < 0.001) were independently associated with the primary outcome. Moreover, the Kaplan–Meier analysis showed a significantly different risk of in-hospital mortality between patients with and without AKI (log-rank: <0.0001). Conclusions: In our investigation, we identified a significant association between AKI and mortality rates among octogenarian patients admitted for COVID-19. These findings raise notable concerns and emphasize the imperative for vigilant monitoring of this demographic cohort. Full article
(This article belongs to the Special Issue COVID-19 and Kidney Disease)
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10 pages, 761 KiB  
Article
Comprehensive Assessment of Eyes in Kidney Transplant Recipients after Recovering from COVID-19
by Mateusz Ślizień, Paulina Sulecka, Leszek Tylicki, Zofia Janicka, Joanna Konopa, Zuzanna Ślizień, Alicja Dębska-Ślizień, Katarzyna Michalska-Małecka and Bogdan Biedunkiewicz
Life 2023, 13(10), 2003; https://doi.org/10.3390/life13102003 - 30 Sep 2023
Viewed by 1000
Abstract
Introduction: Patients after organ transplantation with COVID-19 have a higher risk of morbidity and mortality than patients in the general population. There are single studies that assess the eyes of COVID-19 patients, but there are no such studies on organ transplant recipients. The [...] Read more.
Introduction: Patients after organ transplantation with COVID-19 have a higher risk of morbidity and mortality than patients in the general population. There are single studies that assess the eyes of COVID-19 patients, but there are no such studies on organ transplant recipients. The purpose of this study was to comprehensively examine the eyes of kidney transplant recipients (KTR) after recovery from mild to moderate SARS-CoV-2 infection. Methods: A total of 40 KTR after COVID-19 and 20 KTR without clinical and immunological symptoms of SARS-CoV-2 infection as a control group was qualified for the cross-sectional study. A total of 76 eyes from 38 KTR on an average of 7 weeks after COVID-19 and 36 eyes from 18 KTR from the control group were studied. The participants underwent an ophthalmological examination, and the retinal and choroid vessels and nerves were assessed by optical coherence tomography angiography. Results: We found a lower vessel density (VD) in the deep capillary plexus in the central part of the retina (VD deep central) of the study group. Women had significantly lower VD deep central in the study group (15.51 vs. 18.91, p < 0.001). Multivariate linear regression analysis confirmed an independent, negative impact of COVID-19 (p < 0.001) and female gender (p = 0.001) on VD deep central. Conclusion: The results of our study confirmed that changes in microcirculation induced by SARS-CoV-2 infection may affect the retinal vessels in KTR. Mild to moderate COVID-19 in KTR resulted in a significant reduction in VD deep central of the retina, with these changes being more common in females. Full article
(This article belongs to the Special Issue COVID-19 and Kidney Disease)
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12 pages, 873 KiB  
Article
Incidence, Risk Factors and Mortality Associated with Major Bleeding Events in Hospitalized COVID-19 Patients
by Marko Lucijanic, Ida Tjesic-Drinkovic, Nevenka Piskac Zivkovic, Frane Pastrovic, Zrinka Rob, Mersiha Bacevac, Martina Sedinic Lacko, Eleonora Dzambas, Barbara Medic, Ivan Vukoja, Iva Busic, Ivica Grgurevic, Ivica Luksic and Bruno Barsic
Life 2023, 13(8), 1699; https://doi.org/10.3390/life13081699 - 7 Aug 2023
Cited by 2 | Viewed by 1063
Abstract
Thromboprophylaxis is a mainstay of treatment of hospitalized COVID-19 patients, due to the high occurrence of thrombotic events. This increases the risk of bleeding. However, data on bleeding events and associated risk factors are scarce. Thus, we aimed to investigate the incidence, predictors [...] Read more.
Thromboprophylaxis is a mainstay of treatment of hospitalized COVID-19 patients, due to the high occurrence of thrombotic events. This increases the risk of bleeding. However, data on bleeding events and associated risk factors are scarce. Thus, we aimed to investigate the incidence, predictors and clinical outcomes associated with major bleeding in hospitalized COVID-19 patients. We retrospectively evaluated a cohort of 4014 consecutively hospitalized COVID-19 patients treated in a tertiary-level institution in the period 3/2020–3/2021. Bleeding of any kind was documented in 322 (8%) and major bleeding in 129 (3.2%) patients. A total of 129 (40.1%) bleeding events were present at the time of hospital admission, and 193 (59.9%) occurred during hospitalization. In the multivariate logistic regression analysis, intensive-care-unit treatment (adjusted odds ratio (aOR) 6.55; p < 0.001), atrial fibrillation (aOR 2.55; p = 0.029), higher white-blood-cell count (WBC) (aOR 1.03; p = 0.021), lower hemoglobin (aOR 0.97; p = 0.002) and history of bleeding (aOR 17.39; p < 0.001) were recognized as mutually independent predictors of major bleeding. Major bleeding was significantly associated with increased in-hospital mortality compared to non-major-bleeding patients (59.7% vs. 34.8%, p < 0.001), especially if occurring during hospitalization. Median time from major bleeding to death was 5 days. Bleeding events are frequent in hospitalized COVID-19 patients, with a significant proportion of patients presenting at the time of hospital admission, and others almost universally exposed to anticoagulant and corticosteroid therapies. Major bleeding is associated with high mortality, especially if occurring during hospitalization. The recognition of patients at risk and implementation of timely interventions are of high clinical importance. Full article
(This article belongs to the Special Issue COVID-19 and Kidney Disease)
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Review

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16 pages, 1275 KiB  
Review
The Role of Extracellular Vesicles in SARS-CoV-2-Induced Acute Kidney Injury: An Overview
by Carter Bernal, Christiane How-Volkman, Madison Spencer, Ahmed El-Shamy and Ashraf M. Mohieldin
Life 2024, 14(2), 163; https://doi.org/10.3390/life14020163 - 23 Jan 2024
Viewed by 1293
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected millions worldwide since its outbreak in the winter of 2019. While extensive research has primarily focused on the deleterious respiratory effects of SARS-CoV-2 in recent years, its pan-tropism has become evident. Among the [...] Read more.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected millions worldwide since its outbreak in the winter of 2019. While extensive research has primarily focused on the deleterious respiratory effects of SARS-CoV-2 in recent years, its pan-tropism has become evident. Among the vital organs susceptible to SARS-CoV-2 infection is the kidney. Post SARS-CoV-2 infection, patients have developed coronavirus disease 19 (COVID-19), with reported incidences of COVID-19 patients developing acute kidney injury (AKI). Given COVID-19’s multisystemic manifestation, our review focuses on the impact of SARS-CoV-2 infection within the renal system with an emphasis on the current hypotheses regarding the role of extracellular vesicles (EVs) in SARS-CoV-2 pathogenesis. Emerging studies have shown that SARS-CoV-2 can directly infect the kidney, whereas EVs are involved in the spreading of SARS-CoV-2 particles to other neighboring cells. Once the viral particles are within the kidney system, many proinflammatory signaling pathways are shown to be activated, resulting in AKI. Hence, clinical investigation of urinary proinflammatory components and total urinary extracellular vesicles (uEVs) with viral particles have been used to assess the severity of AKI in patients with COVID-19. Remarkedly, new emerging studies have shown the potential of mesenchymal stem cell-derived EVs (MSC-EVs) and ACE2-containing EVs as a hopeful therapeutic tool to inhibit SARS-CoV-2 RNA replication and block viral entry, respectively. Overall, understanding EVs’ physiological role is crucial and hopefully will rejuvenate our therapeutic approach towards COVID-19 patients with AKI. Full article
(This article belongs to the Special Issue COVID-19 and Kidney Disease)
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14 pages, 732 KiB  
Review
New Insights into the Link between SARS-CoV-2 Infection and Renal Cancer
by Vittoria Rago, Sabrina Bossio, Danilo Lofaro, Anna Perri and Silvia Di Agostino
Life 2024, 14(1), 52; https://doi.org/10.3390/life14010052 - 28 Dec 2023
Viewed by 1139
Abstract
Cancer has been described as a risk factor for greater susceptibility to SARS-CoV-2 infection and severe COVID-19, mainly for patients with metastatic disease. Conversely, to that reported for most solid and hematological malignancies, the few available clinical studies reported that the infection did [...] Read more.
Cancer has been described as a risk factor for greater susceptibility to SARS-CoV-2 infection and severe COVID-19, mainly for patients with metastatic disease. Conversely, to that reported for most solid and hematological malignancies, the few available clinical studies reported that the infection did not increase the risk of death in renal cancer patients. The expression on proximal tubular renal cells of the key players in cellular viral uptake, ACE2, TMPRSS2, and NRP1, seems to be the mechanism for the direct kidney injury seen in patients with COVID-19. Interestingly, data from The Cancer Genome Atlas and experimental analyses on various renal cancer cell lines demonstrated that the above-reported receptors/cofactors are maintained by renal cancer cells. However, whether SARS-CoV-2 infection directly kills renal cancer cells or generates enhanced immunogenicity is a question worth investigating. In addition, some researchers have further addressed the topic by studying the expression and prognostic significance of gene signatures related to SARS-CoV-2 infection in renal cancer patients. The emerging data highlights the importance of better understanding the existence of a link between renal cancer and COVID-19 since it could lead to the identification of new prognostic factors and the development of new therapeutic targets in the management of renal cancer patients. Full article
(This article belongs to the Special Issue COVID-19 and Kidney Disease)
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13 pages, 1615 KiB  
Review
COVID-19 and Kidney: The Importance of Follow-Up and Long-Term Screening
by Vikrant Rai
Life 2023, 13(11), 2137; https://doi.org/10.3390/life13112137 - 30 Oct 2023
Cited by 2 | Viewed by 2041
Abstract
Renal involvement and kidney injury are common in COVID-19 patients, and the symptoms are more severe if the patient already has renal impairment. Renal involvement in COVID-19 is multifactorial, and the renal tubule is mainly affected, along with podocyte injury during SARS-CoV-2 infection. [...] Read more.
Renal involvement and kidney injury are common in COVID-19 patients, and the symptoms are more severe if the patient already has renal impairment. Renal involvement in COVID-19 is multifactorial, and the renal tubule is mainly affected, along with podocyte injury during SARS-CoV-2 infection. Inflammation, complement activation, hypercoagulation, and crosstalk between the kidney and lungs, brain, and heart are contributory factors. Kidney injury during the acute phase, termed acute kidney injury (AKI), may proceed to chronic kidney disease if the patient is discharged with renal impairment. Both AKI and chronic kidney disease (CKD) increase mortality in COVID-19 patients. Further, COVID-19 infection in patients suffering from CKD is more severe and increases the mortality rate. Thus, it is important to address both categories of patients, either developing AKI or CKD after COVID-19 or previously having CKD, with proper management and treatment. This review discusses the pathophysiology involved in AKI and CKD in COVID-19 infection, followed by management and treatment of AKI and CKD. This is followed by a discussion of the importance of screening and treatment of CKD patients infected with COVID-19 and future perspectives to improve treatment in such patients. Full article
(This article belongs to the Special Issue COVID-19 and Kidney Disease)
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11 pages, 277 KiB  
Review
Double J Stents and Reno–Ureteral Lithiasis: Dynamic Changes in Management during the COVID-19 Pandemic
by Adrian Militaru, Catalin Andrei Bulai, Cosmin Ene, Razvan Ionut Popescu, Cosmin Cozma, Cristian Mares, Stefan Balacescu, Cristian Moldoveanu, Dragos Adrian Georgescu, Petrisor Aurelian Geavlete and Bogdan Florin Geavlete
Life 2023, 13(11), 2113; https://doi.org/10.3390/life13112113 - 25 Oct 2023
Viewed by 1045
Abstract
Purpose: To provide an evidence-based review of the use of ureteral stents in managing reno–ureteral lithiasis during the COVID-19 pandemic. Materials and Methods: A literature search was conducted between 2020 and 2023 using the PubMed and SCOPUS databases. As a part of the [...] Read more.
Purpose: To provide an evidence-based review of the use of ureteral stents in managing reno–ureteral lithiasis during the COVID-19 pandemic. Materials and Methods: A literature search was conducted between 2020 and 2023 using the PubMed and SCOPUS databases. As a part of the search query, we entered “ureteral stents” OR “double J stent” AND “renal colic” OR “ureteral obstruction” OR “reno-ureteral lithiasis” AND “COVID-19 Pandemic” OR “SARS-CoV-2 infection”. Results: Patients with lithiasis should be categorized into low priority, intermediate priority, high priority, and emergency under the COVID-19 pandemic scenario to manage their delay and save resources, including healthcare professionals, beds, and ventilators. However, immediate interventions are necessary for individuals at risk of life-threatening septic complications. During the COVID-19 pandemic, the feasibility of conducting or resuming elective activity depended on local circumstances, the accessibility of beds and ventilators, and the execution of screening protocols. If lithiasis surgery is delayed, consequences and increased effort will be inevitable. It is possible that teleconsultation could help guide these patients and cut down on unnecessary visits and exposure. Conclusions: COVID-19 has shifted treatment options for urinary stones, with ureteral stents being a safe, efficient, and cost-effective option for managing urolithiasis. Decompression is essential in emergency situations, while ureteral stents reduce the risk of infection and hospital visits. Full article
(This article belongs to the Special Issue COVID-19 and Kidney Disease)
15 pages, 1863 KiB  
Review
Urine Parameters in Patients with COVID-19 Infection
by Maria Morello, Dominga Amoroso, Felicia Losacco, Marco Viscovo, Massimo Pieri, Sergio Bernardini and Gaspare Adorno
Life 2023, 13(8), 1640; https://doi.org/10.3390/life13081640 - 28 Jul 2023
Cited by 1 | Viewed by 1742
Abstract
A urine test permits the measure of several urinary markers. This is a non-invasive method for early monitoring of potential kidney damage. In COVID-19 patients, alterations of urinary markers were observed. This review aims to evaluate the utility of urinalysis in predicting the [...] Read more.
A urine test permits the measure of several urinary markers. This is a non-invasive method for early monitoring of potential kidney damage. In COVID-19 patients, alterations of urinary markers were observed. This review aims to evaluate the utility of urinalysis in predicting the severity of COVID-19. A total of 68 articles obtained from PubMed studies reported that (i) the severity of disease was related to haematuria and proteinuria and that (ii) typical alterations of the urinary sediment were noticed in COVID-19-associated AKI patients. This review emphasizes that urinalysis and microscopic examination support clinicians in diagnosing and predicting COVID-19 severity. Full article
(This article belongs to the Special Issue COVID-19 and Kidney Disease)
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12 pages, 849 KiB  
Case Report
Acute Renal Vein Thrombosis Following COVID-19 in a Lupus Patient: A Case Report and Review of the Literature
by Dimitra Petrou, Aggeliki Sardeli, Panayiotis Vlachoyiannopoulos, Ornella Moschovaki-Zeiger and Sophia Lionaki
Life 2023, 13(6), 1252; https://doi.org/10.3390/life13061252 - 25 May 2023
Cited by 1 | Viewed by 1168
Abstract
Purpose: The association between COVID-19 and hypercoagulability is well established. This is a case of a patient with systemic lupus erythematosus (SLE) who developed unilateral renal vein thrombosis following COVID-19, the third case described in the international literature so far. Methods: Clinical, [...] Read more.
Purpose: The association between COVID-19 and hypercoagulability is well established. This is a case of a patient with systemic lupus erythematosus (SLE) who developed unilateral renal vein thrombosis following COVID-19, the third case described in the international literature so far. Methods: Clinical, laboratory characteristics and outcomes of the patient were described in detail. Literature review was performed on MEDLINE database via Pubmed. Search items included COVID-19, renal infarction, and renal thrombosis. A total of fifty-three cases were located. Of these, only two patients had renal vein thrombosis but none of them carried a diagnosis of SLE. However, six cases have been published so far involving SLE patients in whom thromboembolic events developed following COVID-19, but none of them experienced renal vein thrombosis. Conclusion: The present case adds a new piece to the emerging puzzle of COVID-19 associated hypercoagulability, especially among patients with autoimmune diseases. Full article
(This article belongs to the Special Issue COVID-19 and Kidney Disease)
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