Am J Physiol Renal Physiol. 2021 Aug 27. doi: 10.1152/ajprenal.00173.2021. Online ahead of print.
Since the start of the COVID-19 pandemic, several manifestations of kidney involvement associated with infection of the SARS-CoV-2 virus have included proteinuria, hematuria, and acute kidney injury (AKI). A growing body of literature has explored risk factors and the pathogenesis of COVID-19-associated AKI, including the direct and indirect mechanisms, as well as early post-discharge outcomes that may result from various manifestation of kidney involvement. In this review, we explore the current state of knowledge of the epidemiology of COVID-19-associated AKI, potential mechanisms and pathogenesis of AKI, and various management strategies for patients in the acute setting. We highlight how kidney replacement therapy for patients with COVID-19-associated AKI has been affected by the increasing demand for dialysis, and how the post-acute management of patients, including outpatient follow-up, is vitally important. We also review what is presently known about long-term kidney outcomes after initial recovery from COVID-19. We provide some guidance as to the management of patients hospitalized with COVID-19 who are at risk for AKI, as well as for future clinical research in the setting of COVID-19 and the significance of early identification of patients at highest risk for adverse kidney outcomes.