Acute kidney injury in severe COVID-19 similar to sepsis-associated issues, study finds


Acute kidney injury associated with the novel coronavirus (COVID-19) resembles sepsis-caused kidney injury, and the immune response triggered by the infection plays a pivotal role, according to new research by the Mayo Clinic published in Mayo Clinic Proceedings.

The findings  also suggest that mitochondrial dysfunction, a loss of function in cellular energy production, is commonly found in kidney injury related to COVID-19. More than one-third of hospitalized COVID-19 patients report acute kidney injury, and sudden kidney failure is a risk factor for in-hospital mortality, according to studies published last year.

Severe COVID-19 disease is known to be associated with a systemic inflammatory response, as well as inflammation in the heart and lungs. Little research is available about immune response in the kidneys, and molecular studies on the renal pathology of COVID-19 patients have been limited.

For the study, researchers evaluated the kidneys of 17 adults who died from COVID-19 and had an autopsy performed at the Mayo Clinic between April 2020 and October 2020. Researchers described the pathological spectrum of the kidney injury related to COVID-19 and characterized its molecular profile, compared with sepsis-associated injury.

The morphological and molecular profile of severe COVID-19 renal injury resembles sepsis renal injury, including microvascular dysfunction, inflammation, and metabolic reprogramming, according to the study.

Of COVID-19 patients admitted to hospital intensive care units, 76 percent have acute kidney injury. Hospitalized COVID-19 patients with secondary acute kidney injury have a nearly 50 percent risk of death, compared with 8 percent among those without kidney injury, according to data published in the Journal of the American Society of Nephrology.

The 17 patients in the Mayo Clinic study had a median age of 78 years, and 15 were male. Most had been hospitalized more than five days before death, and 53 percent reported hypertension as a comorbidity. Other leading comorbidities included diabetes and cardiovascular disease.

"The complex integrated imaging and molecular tests used in this study pave the way to perform similar molecular analyses in different disease conditions to study immune-mediated renal injuries in both native and transplant settings," said Timucin Taner, MD, PhD, senior author of the study and a transplant surgeon and immunologist from the Mayo Clinic, in a statement. "We currently have several projects using this approach, with the goal being to identify the underlying mechanisms of different diseases, so we can help physicians treat these conditions more effectively."

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