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
Research background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can result in clinically significant multi-system disease, including involvement in the kidney. A wide range of histopathological findings have been reported in kidney biopsies in association with coronavirus disease 2019 (COVID-19) infection.

Research motivation

Renal dysfunction in COVID-19 infection is reported in association with multiple pathologies. However, the mechanism behind these pathologies is not well understood.

Research objectives

This systematic review was conducted to provide an overview of the current literature on the renal histopathological features and mechanistic insights described in association with COVID-19 infection.

Research methods

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”. Data on presentation, histological features, management and outcome was extracted from the reported studies.

Research results

Our review identified a total of 59 studies reporting COVID-19 related histopathological diagnoses from kidney biopsy. Of these 59 studies, 30 reported on native kidney biopsies, nine reported on transplant biopsies, three reported on a mixture of native and transplant kidney biopsies and 17 reported on postmortem kidney biopsies. In total, there were 84 native biopsies, 15 transplant biopsies, and 189 postmortem biopsies. Many histopathological features were described, including acute tubular injury (ATI), collapsing focal segmental glomerular sclerosis, thrombotic microangiopathy and vasculitis.

Research conclusions

Many other histopathological processes were observed in association with COVID-19 in addition to the expected ATI, highlighting the need for an early kidney biopsy.

Research perspectives

Whilst the underlying pathological processes of a few conditions developing due to COVID-19 infection can be hypothesized based on our current understanding of kidney disease, further work is required to determine what, if any, is the link between COVID-19 and some of the other processes described.