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Long COVID and the kidney

Nature Reviews Nephrology (2025)Cite this article

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Abstract

Long coronavirus disease (COVID) — commonly defined as symptoms and/or long-term effects that persist for at least 3 months after acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and cannot be explained by an alternative diagnosis — is a complex, multifaceted and heterogeneous disease that affects many organ systems, including the kidney. COVID-19 can cause acute kidney injury, and several studies have reported an increased risk of chronic kidney disease (CKD) following COVID-19, suggesting that CKD can be a manifestation of long COVID. Furthermore, patients with CKD are at an increased risk of severe COVID-19 and of long COVID. COVID-19 has also been associated with the development of COVID-19-associated nephropathy, which is a collapsing form of focal segmental glomerulosclerosis, and an increased incidence of new-onset vasculitis. Some early reports described associations of COVID-19 and/or SARS-CoV-2 vaccines with relapse or new-onset of other glomerular diseases, but this link was not confirmed in large population-based studies. SARS-CoV-2 vaccination reduces the risk of COVID-19 and long COVID and is particularly important for protecting vulnerable populations such as patients with CKD. Structured long-term follow-up of patients with COVID-19 and post-infectious sequelae is needed to provide further insight into the trajectory of long COVID and enable identification of those at risk of CKD.

Key points

  • Long coronavirus disease (COVID) is commonly defined as symptoms or long-term effects that persist for at least 3 months after acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and cannot be explained by an alternative diagnosis; this disorder can affect many organ systems, including the kidney.

  • Pathophysiological mechanisms that underlie the high risk of acute kidney injury in patients with COVID-19 might also contribute to the development of chronic kidney disease (CKD) as one of the manifestations of long COVID.

  • Patients with CKD are at an increased risk of SARS-CoV-2 infection and severe COVID-19 outcomes and might also be at increased risk of long COVID.

  • COVID-19 is associated with COVID-associated nephropathy, which is a rare but severe kidney disease; other relapsing or new-onset glomerular diseases have not been consistently associated with COVID-19, and there is also no proven causative association with SARS-CoV-2 vaccines.

  • SARS-CoV vaccines are safe and efficacious in patients with CKD and are associated with a reduced risk of long COVID.

  • Structured long-term follow-up of patients with COVID-19 is required to provide further insight into long COVID and enable the identification of patients who are at risk of the development or progression of CKD to facilitate timely intervention.

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Fig. 1: Signs and symptoms of long coronavirus disease.
Fig. 2: Potential mechanisms and risk factors that may contribute to the development of chronic kidney disease following COVID-19.
Fig. 3: Potential mechanisms that might contribute to new-onset or relapse of glomerular disease following COVID-19.
Fig. 4: Potential mechanisms that might contribute to new onset or relapse of glomerular disease following SARS-CoV-2 vaccination.

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Authors and Affiliations

  1. Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden

    Vanja Ivković, Andreas Kronbichler & Annette Bruchfeld

  2. Department of Nephrology, Amrita Institute of Medical Sciences, New Delhi, India

    Urmila Anandh

  3. Division of Population Health and Genomics, University of Dundee, Dundee, UK

    Samira Bell

  4. Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria

    Andreas Kronbichler

  5. Nephrology Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain

    Maria Jose Soler

  6. Nephrology Research Group, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain

    Maria Jose Soler

  7. Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institutet, Stockholm, Sweden

    Annette Bruchfeld

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All authors researched data for the article, contributed substantially to discussion of the content, wrote the article and reviewed and/or edited the manuscript before submission.

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U.A. reports no competing interests; V.I. has received a Long-term Fellowship grant from the European Renal Association (ERA) and is an Editorial Board member of NDT; S.B. reports consultancy fees from AstraZeneca, Bayer and GSK; A.K. reports consulting fees from Amgen, AstraZeneca, Boehringer Ingelheim, CSL Vifor, Delta4, GlaxoSmithKline, Novartis, Otsuka, Roche and Walden Biosciences, all outside of the submitted work. A.K. serves as an Associate Editor of Glomerular Diseases and an Editor of NDT. M.J.S. reports personal fees from NovoNordisk, Jansen, Mundipharma, AstraZeneca, Esteve, Fresenius, Ingelheim Lilly, Vifor and ICU, and grants and personal fees from Boehringer Ingelheim; A.B. received consultancy fees from Amgen, AstraZeneca, Boehringer Ingelheim, CSL Vifor, Otsuka and Sobi and payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing or educational events from AstraZeneca, Bayer, Boehringer Ingelheim, ChemoCentryx, CSL Vifor, Fresenius, GlaxoSmithKline and Otsuka; A.B. is an Editorial Board member of CKJ.

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Ivković, V., Anandh, U., Bell, S. et al. Long COVID and the kidney. Nat Rev Nephrol (2025). https://doi.org/10.1038/s41581-025-00997-4

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