Background: Viral infections persist globally, among all age groups, race, and gender. Kidney injuries caused by several viral diseases have been reported across the world. Of particular importance is the SARS-CoV-2 (COVID-19), and its prevalence in communities infecting all patient populations with symptoms ranging from asymptomatic to severe, including complications and mortality. The most common kidney diseases associated with COVID-19 are acute kidney injury (AKI), chronic kidney disease (CKD), end-stage renal disease (ESRD), and glomerular disease. 

Hypothesis and Aim: The hypothesis is COVID-19 causes renal dysfunction through different mechanisms other than common viral infections such as, common flu, H1N1, hepatitis, HIV and SARS.  The goals of the study were to compare COVID-19 induced renal dysfunction with other common viral associated renal pathologies and to determine the specific mechanism(s) of COVID-19 leading to nephrotoxicity and renal impairment.  Relevant search terms contributing to the study objective were used across electronic platforms such as, PubMed, Scopus, and Google Scholar, up to April 2021.  The Centers for Disease Control and Prevention (CDC) was referenced for current reported information regarding the viruses. Lexi-Comp was used for drug-specific information. 

Results: The CDC reports 5% of hospitalized COVID-19 patients develop acute kidney injury (AKI). Patients most at risk for developing AKI are those who are older age (> 65), males, and who have an increased body mass index, indicating obesity (BMI 34 kg/m²). The age range, 75-84, had the highest number of COVID-19 deaths contributing to renal failure reported on their death certificates. The second highest group was 85+, and third highest, 65-74. Ages associated with an increased risk of complications for common flu were <5 and >65. Those at increased risk for CKD with hepatitis were >60. Increased risk for kidney disease with HIV were those 20-64. H1N1 showed an increased risk of morbidity with <20 and >80 and an increased risk of mortality for 25-49. SARS demonstrated a 59% increased risk for 18-64 versus a 21% increased risk for >65. COVID-19, H1N1, and HIV-associated renal disease were more prevalent in males. Renal impairment with common flu and hepatitis were higher in females. COVID-19 renal dysfunction was more frequently diagnosed with those who had a higher BMI (34 kg/m²). This was similar between common flu and H1N1. HIV-renal dysfunction correlated with a lower BMI (18.5 kg/m²). The specific mechanisms for the development of renal disease from COVID-19 include direct renal tubular injury, cytokine storm, inflammation, and thrombosis. Mechanisms of the common viral infections resulting in renal injury are acute tubular necrosis, thrombotic events, direct renal injury, and inflammatory processes.

Keywords: COVID-19, viral pathologies, renal dysfunction