Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Nov 18, 2021; 11(11): 480-502
Published online Nov 18, 2021. doi: 10.5500/wjt.v11.i11.480
Native and transplant kidney histopathological manifestations in association with COVID-19 infection: A systematic review
Vishnu Jeyalan, Joshua Storrar, Henry H L Wu, Arvind Ponnusamy, Smeeta Sinha, Philip A Kalra, Rajkumar Chinnadurai
Vishnu Jeyalan, Henry H L Wu, Arvind Ponnusamy, Department of Renal Medicine, Royal Preston Hospital, Preston PR2 9HT, United Kingdom
Joshua Storrar, Smeeta Sinha, Philip A Kalra, Rajkumar Chinnadurai, Department of Renal Medicine, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, United Kingdom
Joshua Storrar, Smeeta Sinha, Philip A Kalra, Rajkumar Chinnadurai, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, United Kingdom
Author contributions: Jeyalan V, Storrar J, Wu HHL, and Chinnadurai R performed the conception/design of the study, acquisition, analysis and interpretation of data, manuscript drafting, critical revision, final approval; Ponnusamy A performed the conception/design of the study, critical revision, final approval; Sinha S, and Kalra PA performed the critical revision, final approval.
Conflict-of-interest statement: The authors have no conflict of interest and no financial ties to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Rajkumar Chinnadurai, MRCP, PhD, Consultant Physician-Scientist, Department of Renal Medicine, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford M6 8HD, United Kingdom.
Received: March 31, 2021
Peer-review started: March 31, 2021
First decision: July 29, 2021
Revised: August 5, 2021
Accepted: October 31, 2021
Article in press: October 31, 2021
Published online: November 18, 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can result in clinically significant multi-system disease including involvement in the kidney. The underlying histopathological processes were unknown at the start of the pandemic. As case reports and series have been published describing the underlying renal histopathology from kidney biopsies, we have started to gain an insight into the renal manifestations of this novel disease.


To provide an overview of the current literature on the renal histopathological features and mechanistic insights described in association with coronavirus disease 2019 (COVID-19) infection.


A systematic review was performed by conducting a literature search in the following websites-‘PubMed’, ‘Web of Science’, ‘Embase’ and ‘Medline-ProQuest’ with the following search terms-“COVID-19 AND kidney biopsy”, “COVID-19 AND renal biopsy”, “SARS-CoV-2 AND kidney biopsy” and “SARS-CoV-2 AND renal biopsy”. We have included published data up until February 15, 2021, which includes kidney biopsies (native, transplant and postmortem) from patients with COVID-19. Data on clinical presentation, histopathological features, management and outcome was extracted from the reported studies.


The total number of biopsies reported on here is 288, of which 189 are postmortem, 84 native and 15 transplants. The results are varied and show underlying pathologies ranging from collapsing glomerulopathy and acute tubular injury (ATI) to anti-nuclear cytoplasmic antibody associated vasculitis and pigment nephropathy. There was variation in the specific treatment used for the various renal conditions, which included steroids, hydroxychloroquine, eculizumab, convalescent plasma, rituximab, anakinra, cyclophosphamide and renal replacement therapy, amongst others. The pathological process which occurs in the kidney following COVID-19 infection and leads to the described biopsy findings has been hypothesized in some conditions but not others (for example, sepsis related hypoperfusion for ATI). It is important to note that this represents a very small minority of the total number of cases of COVID-19 related kidney disease, and as such there may be inherent selection bias in the results described. Further work will be required to determine the pathogenetic link, if any, between COVID-19 and the other renal pathologies.


This report has clinical relevance as certain renal pathologies have specific management, with the implication that kidney biopsy in the setting of renal disease and COVID-19 should be an early consideration, dependent upon the clinical presentation.

Keywords: COVID-19, Histopathology, Kidney biopsy, Transplant, SARS-CoV-2

Core Tip: Coronavirus disease 2019 (COVID-19) affects multiple organ systems, including the kidneys resulting in acute kidney injury. Multiple pathologies and different mechanisms have been attributed to the pathogenesis of kidney disease in COVID-19. This systematic review aims to provide an overview of the histopathological findings reported in kidney biopsies associated with COVID-19 infection.