The Novel Coronavirus 2019 Epidemic and the Kidneys

Main Article Content

Maurizio Salvadori
Aris Tsalouchos


acute kidney injury, coronavirus disease, hemodialysis patients, renal transplant patients, treatment of COVID-19


The Severe Acute Respiratory Syndrome Coronavirus 2 is a recent disease that originated in China by the end of 2019. The origins of the disease can be traced to bats, but it has been transmitted to humans, and the inter human transmission is particularly rampant which has led to a pandemic of unseen proportions.
The organ principally involved is the lungs, and severe pneumonia with lack of oxygen leads to fatalities.

The aim of this review was to study the involvement of the kidneys with regard to COVID-19 infection and how the disease may affect people on hemodialysis or those who have undergone a kidney transplant.

Indeed, the virus, in addition to the lungs, may affect other vascularized organs to a common receptor on lung epithelium and the endothelium of any organ.
The kidney, which has a large endothelium surface, is affected, and COVID-19 may lead to acute renal failure.

On the other hand, the virus may easily spread among people who are on hemodialysis three times a week. People on hemodialysis may have low immunity, and the virus may have dangerous effects on such people.
Finally, renal transplant patients may be easily affected, and the virus may have severe consequences, even death.

We will summarize the principal prophylactic measures to be adopted and the therapeutic measures available. Clearly due to the recent occurrence of the pandemic the majority these measures lack a basis in evidence-based medicine and only highlight the efforts to limit COVID-19 induced damage.


Download data is not yet available.
Abstract 2324 | PDF Downloads 287 HTML Downloads 8 XML Downloads 35


1. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020 Feb 7;323(11):1061–9.
2. World Health Organization. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003 [Internet]. [cited 2020 Apr 27]. Available from: csr/sars/country//table2004_04_21/en/
3. World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV). November 2019 [Internet]. [cited 2020 Apr 27]. Available from: http://www/ mers-cov/en/
4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical fea-tures of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. S0140-6736(20)30183-5
5. Center for Disease Control and Prevention. Frequently asked questions and answers: Coronavirus Disease-2019 (COVID 19) and children [Internet]. [cited 2020 May 2]. Available from: children-faq.html
6. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study Lancet. 2020 Feb 15;395(10223):507–13. http://dx.doi. org/10.1016/S0140-6736(20)30211-7
7. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–20. NEJMoa2002032
8. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020 May;97(5):829–38. http://dx.
9. Naicker S, Yang CW, Hwang SJ, Liu BC, Chen JH, Jha V. The novel coronavirus 2019 epidemic and kidneys. Kidney Int. 2020 May;97(5):824–8.
10. Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: A prospective cohort study. Lancet. 2020 May 19. Online ahead of print.
11. Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020 May 13;S0085-2538(20)30532-9. http://dx. Online ahead of print.
12. Gross O, Moerer O, Weber M, Huber TB, Scheithauer S. COVID-19-associated nephritis: Early warning for disease severity and complications? Lancet. 2020 May 16;395(10236):e87–e88. http://
13. Su H, Yang M, Wan C, Yi LX, Tang F, Zhu HY, et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. 2020 Apr 9;S0085-2538(20)30369-0.
14. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS. Endothelial cell infection and endothelii-tis in COVID-19. Lancet. 2020;395:1417–18. http://dx.doi. org/10.1016/S0140-6736(20)30937-5
15. Dong N, Cai J, Zhou Y, Liu J, Li F. End-stage heart failure with COVID-19: Strong evidence of myocardial injury by 2019-nCoV. JACC Heart Fail. 2020 Apr 7;S2213-1779(20)30200-6.
16. Diao B, Wang C, Wang R, Feng Z, Tan Y, Wang H, et al. Human kidney is a target for novel severe acute respiratory syndrome coro-navirus 2 (SARS-CoV-2) Infection. medRxiv. 1101/2020.03.04.20031120. e-published ahead of print
17. Yalameha B, Roshan B, Bhaskar L, Mohmoodnia L Perspectives on the relationship of renal disease and coronavirus disease 2019. J Nephropharmacol. 2020;9(2):e22.
18. Batlle D, Soler MJ, Sparks MA, Hiremath S, South AM, Welling PA. Acute kidney injury in COVID-19: Emerging evidence of a distinct pathophysiology. JASN. May 2020;ASN.2020040419. published online ahead of print
19. Larsen CP, Bourne TD, Wilson JD, Saqqa O, Sharshir MA. Collapsing glomerulopathy in a patient with coronavirus disease 2019 (COVID-19). Kidney Int Rep. 2020 Apr 9. http://dx.doi. org/10.1016/j.ekir.2020.04.002. Online ahead of print.
20. Peleg Y, Kudose S, D’Agati V, Siddall E, Ahmad S, Kisselev S, et al. Acute kidney injury due to collapsing glomerulopathy following COVID-19 Infection. Kidney Int Rep. 2020 Apr 28. Online ahead of print.
21. Genovese G, Friedman DJ, Ross MD, Lecordier L, Uzureau P, Freedman BI, et al. Association of trypanolytic ApoL1 vari-ants with kidney disease in African Americans. Science. 2010 Aug 13;329(5993):841–5.
22. Hong XW, Chi ZP, Liu GY, Huang H, Guo SQ, Fan Jr, et al. Analysis of early renal injury in COVID-19 and diagnostic value of multi-index combined detection. MedRxiv. 2020. http://dx.
23. Xie Z, Bao J, Cai Z, Liu S, Chen H, Qi J, et al. Clinical char-acteristics of 60 COVID-19-infected patients with or 2 without renal injury in Hangzhou, China [Internet]. Available from: SSRN:
24. Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal involvement and early prognosis in patients with COVID-19 pneumonia. JASN. 2020;31(6):1157–65. http://dx.doi. org/10.1681/ASN.2020030276
25. Jia HP, Look DC, Shi L, Hickey M, Pewe L, Netland J, et al. ACE2 receptor expression and severe acute respiratory syn-drome coronavirus infection depend on differentiation of human airway epithelia. J Virol. 2005;79:14614–21. http://dx.
26. Wilson PC, Wu H, Kirita Y, Uchimura K, Ledru N, Rennke HG, et al. The single-cell transcriptomic landscape of early human diabetic nephropathy. Proc Natl Acad Sci U S A. 2019;116:19619–25.
27. Walls AC, Park YJ, Tortorici MA, Wall A, McGuire AT, Veesler  D. Structure, function, and antigenicity of the SARS-CoV-2 Spike glycoprotein. Cell. 2020;181:281–292.e6. http://dx.
28. Ye M , Wysocki J, William J, Soler MJ, Cokic I, Batlle D. Glomerular localization and expression of angiotensin-convert-ing enzyme 2 and angiotensin-converting enzyme: Implications for albuminuria in diabetes. J Am Soc Nephrol. 2006 Nov;17(11):3067–75.
29. Suwanwongse K, Shabarek N. Rhabdomyolysis as a presen-tation of 2019 novel coronavirus disease. Cureus. 2020 Apr 6;12(4):e7561.
30. Park HC, Lee YK, Lee SH, Yoo KD, Jeon HJ, Ryu DR, et al. Middle east respiratory syndrome clinical prac-tice guideline for hemodialysis facilities. Kidney Res Clin Pract. 2017 Jun;36(2):111–16. krcp.2017.36.2.111
31. Park HC, Lee SH, Kim J, Kim DH , Cho AJ , Jeon HJ, et al. Effect of isolation practice on the transmission of middle east respiratory syndrome coronavirus among hemodial-ysis patients: A 2-year prospective cohort study. Medicine (Baltimore). 2020 Jan;99(3):e18782. MD.0000000000018782
32. Alan S, Kliger AS, Silberzweig J. Mitigating risk of COVID-19 in dialysis facilities. CJASN. 2020;15:707–9. http://dx.doi. org/10.2215/CJN.03340320
33. Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ. Rational use of face masks in the COVID-19 pandemic [Internet]. Available from: Published Online March 20, 2020.
34. WHO. Coronavirus disease (COVID-19) advice for the pub-lic: When and how to use masks. 2020 [Internet]. [cited 2020 Mar 17]. Available from: diseases/novelcoronavirus-2019/advice-for-public/when-and-how-to-use-masks
35. State Council, China. Guidelines for the selection and use of different types of masks for preventing new coronavirus infec-tion in different populations 2020 (in Chinese) [Internet]. Feb 5, 2020. [cited 2020 Mar 17]. Available from: xinwen/2020-02/05/content_5474774.htm
36. The Department of Health, Hong Kong. Guidelines on prevention of coronavirus disease 2019 (COVID-19) for the general public. March 13, 2020 [Internet]. [cited 2020 Mar 17]. Available from: nid_guideline_general_public_en.pdf
37. Ministry of Health, Singapore. Updates on COVID-19 (corona-virus disease2019) local situation [Internet]. [cited 2020 Mar 17]. Available from:
38. Ministry of Health, Labour and Welfare, Japan. Q & A on coronavirus 2019(COVID-19): When should I wear a face-mask? [Internet]. 2020 [cited 2020 Mar 17]. Available from: dengue_fever_qa_00014.html
39. CDC. Coronavirus Disease 2019 (COVID-19): Steps to prevent illness [Internet]. [cited 2020 Mar 17]. Available from: html
40. National Health Service. Are face masks useful for preventing coronavirus? [Internet]. 2020 [cited 2020 Mar 5]. Available from: questions/
41. Federal Ministry of Health, Germany. Daily updates on the coronavirus: Is wearing a surgical mask, as protection against acute respiratory infections, useful for members of the general public? [Internet]. 2020 [cited 2020 Mar 5]. Available from: coronavirus.html
42. Basile C, Combe C, Pizzarelli F, Covic A, Davenport A, Kanbay M, et al. Recommendations for the prevention, mitiga-tion and containment of the emerging SARS-CoV-2 (COVID-19) pandemic in haemodialysis centres. Nephrol Dial Transplant. 2020;35:737–41.
43. Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola  A, et al. A report from the Brescia Renal COVID Task Force on the clinical characteristics and short-term outcome of hemodialysis patients with SARS-CoV-2 infection. Kidney Int. 2020. epub ahead of print kint.2020.04.030
44. Alhenc-Gelas F, Drueke TB. Blockade of SARS-CoV-2 infec-tion by recombinant soluble ACE2. Kidney Int. 2020;97:1091–3.
45. Multicenter Collaboration Group of Department of Science and Technology of Guangdong Province and Health Commission of Guangdong Province for chloroquine in the treatment of novel coronavirus pneumonia. [Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43:185–8.
46. Cortegiani A, Ingoglia G, Ippolito M, Einav S. Chloroquine for COVID-19: Rationale, facts. Hopes Crit Care. 2020 May 8;24(1):210–13.
47. Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe  M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open label non-randomized clinical trial [e-pub ahead of print]. Int J Antimicrob Agents. 2020 Mar 20:105949. ijantimicag.2020.105949. Epub ahead of print
48. Naksuk N, Lazar S, Peeraphatdit TB. Cardiac safety of off-label COVID-19 drug therapy: A review and pro-posed monitoring protocol. Eur Heart J Acute Cardiovasc Care. 2020 May 6;2048872620922784. http://dx.doi. org/10.1177/2048872620922784. Online ahead of print.
49. Erickson TB, Chai PR, Boyer EW. Chloroquine, hydroxychloro-quine and COVID-19. Toxicol Commun. 2020;4(1):40–2. http:// Epub 2020 Apr 30
50. Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19 [e-pub ahead of print]. N Engl J Med. 2020 May 7;382(19):1787–99.
51. Sheahan TP, Sims AC, Leist SR, Schäfer A, Won J, Brown AJ, et al. Comparative therapeutic efficacy of remdesivir and com-bination lopinavir, ritonavir, and interferon beta against MERS-CoV. Nat Commun. 2020 Jan 10;11(1):222–36. http://dx.doi. org/10.1038/s41467-019-13940-6
52. de Wit E, Feldmann F, Cronin J, Jordan R, Okumura A, Thomas T, et al. Prophylactic and therapeutic remdesivir (GS-5734) treatment in the rhesus macaque model of MERS-CoV infection. Proc Natl Acad Sci U S A. 2020;117(12):6771–6.
53. Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30(3):269–71.
54. Bloch EM , Shoham S , Casadevall A , Sachais BS , Shaz B, Winters JL , et al. Deployment of convalescent plasma for the prevention and treatment of COVID-19. J Clin Invest. 2020 Apr 7;138745. Online ahead of print.
55. Frey N, Porter D. Cytokine release syndrome with chimeric antigen receptor T cell therapy. Biol Blood Marrow Transplant. 2019;25(4):e123–7.
56. Porfidia A, Pola R. Venous thromboembolism and hepa-rin use in COVID-19 patients: Juggling between pragmatic choices, suggestions of medical societies and the lack of guide-lines. J Thromb Thrombolysis. 2020 May 16;1. http://dx.doi. org/10.1007/s11239-020-02139-y. Online ahead of print.
57. Pachetti M, Marini B, Benedetti F, Fabiola Giudici F , Elisabetta Mauro E , Paola Storici P , et al. Emerging SARS-CoV-2 muta-tion hot spots include a novel RNA-dependent-RNA poly-merase variant. Transl Med. 2020 Apr 22;18(1):179. http://
58. Zhu L, Xu X, Ma K, Yang J, Guan H, Chen S, et al. Successful recovery of COVID-19 pneumonia in a renal transplant recipi-ent with long-term immunosuppression. Am J Transplant. 2020 Mar 17;10:1–5.
59. Guillen E, Pineiro GJ, Revuelta I, Rodriguez D, Bodro M, Moreno A, et al. Case report of COVID-19 in a kidney trans-plant recipient: Does immunosuppression alter the clinical presentation? Am J Transplant. 2020 Mar 20. http://dx.doi. org/10.1111/ajt.15874. Online ahead of print.
60. Gandolfini I, Delsante M, Fiaccadori E, Zaza G, Manenti L, Degli Antoni A, et al. COVID-19 in kidney transplant recipi-ents. Am J Transplant. 2020 Mar 31. ajt.15891. Online ahead of print.
61. Akalin E, Azzi Y, Bartash R, Seethamraju H, Parides M, Hemmige V, et al. Covid-19 and kidney transplantation. N Engl J Med. 2020 Apr 24;NEJMc2011117. NEJMc2011117. Online ahead of print.
62. Nair V, Jandovitz N, Hirsch JS, Nair G, Abate M, Bhaskaran M, et al. COVID-19 in kidney transplant recipients. Am J Transplant. 2020 Apr 29. Online ahead of print.
63. Columbia University. Kidney transplant program early descrip-tion of coronavirus 2019 disease in kidney transplant recipients in New York. J Am Soc Nephrol. 2020 Apr 21;ASN.2020030375. Online ahead of print.
64. Abrishami A , Samavat S, Behnam B, Arab-Ahmadi M, Nafar M, Taheri MS, et al. Clinical course, imaging features, and out-comes of COVID-19 in kidney transplant recipients. Eur Urol. 2020 May 6;S0302-2838(20)30332-8. eururo.2020.04.064. Online ahead of print.
65. Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola  A. Management of patients on dialysis and with kidney transplant during SARS-COV-2 (COVID-19) pandemic in Brescia, Italy. Kidney Int Rep. 2020 Apr 4;5(5):580–5. http://dx.
66. Michaels MG, La Hoz RM, Danziger-Isakov L, Blumberg EA, Kumar D, Green M, et al. Coronavirus disease 2019: Implications of emerging infections for transplantation. Am J Transplant. 2020 Feb 24. Online ahead of print.
67. Centre for Disease Control. Follow updated guidelines [Internet]. [cited 2020 May 8]. Available from: https://www.cdc. gov/coronavirus/2019-ncov/infection-control.html
68. ERA-EDTA. WG Descartes expert opinion regarding the management of immunosuppressive medication for kidney transplant patients during the COVID-19 pandemic [Internet]. [cited 2020 Apr 6]. Available from: en/wp-content/uploads/2029/04/Expert-opinion-on-ISD-in-Covid-19.pdf
69. American Society of Transplantation. 2019-nCoV (Coronavirus): FAQs for organ donation and transplanta-tion [Internet]. Updated March 30, 2020 [cited 2020 May 8]. Available from:
70. Angelico R, Trapani S, Manzia TM, Lombardini L, Tisone G, Cardillo M. The COVID-19 outbreak in Italy: Initial implica-tions for organ transplantation programs. Am J Transplant. 2020 Apr 3. Online ahead of print.