Immune Response in COVID-19-associated Acute Kidney Injury and Maladaptive Kidney Repair

Abstract

ABSTRACT Acute kidney injury (AKI) is a major disease with substantial short and long-term morbidity and mortality. It is also a critical consequence of coronavirus disease 2019 (COVID-19), which is characterized by a robust immunological response and a cytokine storm. Current COVID-19-AKI prevention and management approaches are largely based on clinical experience, and further research is required to obtain evidence to support current clinical practices and to develop new treatment and care strategies. Several individuals have reported experiencing long-term symptoms indicative of the long COVID syndrome following COVID-19 infection. Evidence of the long-term consequences of COVID-19 on kidneys has also been reported. In this aspect, the kidney has a remarkable capacity for repair after injury. However, when the injury is too severe or persistent, kidney repair is incomplete and maladaptive, potentially leading to chronic kidney disease (CKD). Inflammation, characterized by complex crosstalk between intrinsic renal cells and immune cells, is critical in maladaptive kidney repair. In this review, we summarize the progress of studies on COVID-19-induced AKI and the interactions between immune cells and intrinsic renal cells involved in the process of maladaptive kidney repair. We also discuss inflammation-related pathways as potential therapeutic targets.