Henry HL Wu | The University of Manchester (original) (raw)

Papers by Henry HL Wu

Hemodialysis International

An increasing demand for in-center dialysis services has been largely driven by a rapid growth of... more An increasing demand for in-center dialysis services has been largely driven by a rapid growth of the older population progressing to end-stage kidney disease. Since the onset of the COVID-19 pandemic, efforts to encourage homebased dialysis options have increased due to risks of infective transmission for patients receiving hemodialysis in center-based units. There are various practical and clinical advantages for patients receiving hemodialysis at home. However, the lack of caregiver support, cognitive and physical impairment, challenges of vascular access, and preparation and training for home hemodialysis (HHD) initiation may present as barriers to successful implementation of HHD in the older dialysis population. Assessment of an older patient's frailty status may help clinicians guide patients when making decisions about HHD. The development of an assisted HHD care delivery model and advancement of telehealth and technology in provision of HHD care may increase accessibility of HHD services for older patients. This review examines these factors and explores current unmet needs and barriers to increasing access, inclusion, and opportunities of HHD for the older dialysis population.

Clinical Kidney Journal

There is a rising demand for dialysis in the older population given the increased numbers of olde... more There is a rising demand for dialysis in the older population given the increased numbers of older adults living with chronic kidney disease (CKD) progressing to kidney failure. Home dialysis, i.e. peritoneal dialysis (PD) and home hemodialysis (HHD), has been available for decades, but more recently there has been a rapid increase in home dialysis utilization as patients and clinicians consider its practical and clinical advantages. For older adults, incident home dialysis utilization more than doubled and prevalent home dialysis growth nearly doubled over the past decade. Whilst its advantages and recent rise in popularity are evident, there are numerous barriers and challenges that are important to consider prior to initiating older adults on home dialysis. Some nephrology healthcare professionals do not view home dialysis as an option for older adults. Successful delivery of home dialysis for older adults may be made even more difficult by physical or cognitive limitations, conc...

Rheumatology Advances in Practice

Children

Global COVID-19 vaccination programs for children and adolescents have been developed with intern... more Global COVID-19 vaccination programs for children and adolescents have been developed with international clinical trial data confirming COVID-19 mRNA vaccine safety and efficacy for the pediatric population. The impact of COVID-19 vaccination in the kidneys is thought to be explained by a complex immune-mediated relationship between the two, although the pathophysiological mechanisms of how COVID-19 vaccination potentially induces kidney pathology are not presently well known. Whilst intrinsic kidney pathologies following COVID-19 vaccination have been reported in adults, such cases are only being recently reported with greater frequency in children and adolescents. Conforming to the PRISMA checklist, we conducted a systematic review of the current literature to provide an overview on the range of intrinsic kidney pathologies that have been reported following COVID-19 vaccination in children and adolescents. All English language research articles published on or before 30 June 2022 ...

Allergies

Chronic kidney disease-associated pruritus (CKDaP) is an often under-diagnosed and under-recogniz... more Chronic kidney disease-associated pruritus (CKDaP) is an often under-diagnosed and under-recognized condition, despite its considerable prevalence within the chronic kidney disease (CKD) population. Universally accepted guidelines are also lacking. The true prevalence of CKDaP worldwide therefore remains unknown, although its negative impact on mortality and health-related quality of life outcomes is very clear. The pathophysiological mechanisms leading to the onset of CKDaP are only partly understood. CKDaP is currently believed to be caused by a multifactorial process, from local skin changes, metabolic alterations, the development of neuropathy and dysregulation of opioid pathways, and psychological factors. Much work has been carried out towards a more systematic and structured approach to clinical diagnosis. Various tools are now available to assess the severity of CKDaP. Many of these tools require greater validation before they can be incorporated into the guidelines and into...

Kidney and Dialysis

Anemia in chronic kidney disease (CKD) has become an important clinical issue with the increased ... more Anemia in chronic kidney disease (CKD) has become an important clinical issue with the increased prevalence of elderly patients living with CKD progressing to kidney failure. The causes of anemia in elderly individuals tend to be multifactorial, exacerbated by the physiological effects of aging, frailty and declining kidney function. Erythropoiesis-stimulating agents (ESAs) are the conventional therapeutic option for anemia in CKD. However, ESA hyporesponsiveness is a commonly observed issue in clinical practice and an issue that is more challenging to resolve in elderly patients living with frailty, kidney disease, and multi-morbidities. Following the emergence of oral hypoxia-induced factor prolyl-hydroxylase inhibitors (HIF-PHI) in recent years, there is discussion on whether it is a solution to the conundrum of ESA hyporesponsiveness, as HIF-PHI treats anemia via an alternative physiological pathway. There remains uncertainty on the suitability of HIF-PHI use in elderly patients...

International Journal of Molecular Sciences

Chronic kidney disease (CKD) is a global health issue, affecting more than 10% of the worldwide p... more Chronic kidney disease (CKD) is a global health issue, affecting more than 10% of the worldwide population. The current approach for formal diagnosis and prognostication of CKD typically relies on non-invasive serum and urine biomarkers such as serum creatinine and albuminuria. However, histological evidence of tubulointerstitial fibrosis is the ‘gold standard’ marker of the likelihood of disease progression. The development of novel biomedical technologies to evaluate exfoliated kidney cells from urine for non-invasive diagnosis and prognostication of CKD presents opportunities to avoid kidney biopsy for the purpose of prognostication. Efforts to apply these technologies more widely in clinical practice are encouraged, given their potential as a cost-effective approach, and no risk of post-biopsy complications such as bleeding, pain and hospitalization. The identification of biomarkers in exfoliated kidney cells from urine via western blotting, enzyme-linked immunosorbent assay (EL...

Vaccines, 2022

Background: The advancement of COVID-19 vaccination programs globally has been viewed as an integ... more Background: The advancement of COVID-19 vaccination programs globally has been viewed as an integral strategy to reduce both the number of COVID-19 cases and consequential complications of COVID-19, particularly for high-risk patient groups. There are limited data on the antibody response and protection from disease infection and severity in patients requiring hemodialysis (HD) following COVID-19 vaccination during the Delta and Omicron variant predominance. We conducted a study aiming to evaluate humoral immunity derived from two different COVID-19 vaccines administered to our in-centre HD population and investigated the characteristics of breakthrough COVID-19 infections occurring post-vaccination within this population. Methods: This is a prospective observational study including patients receiving HD at Salford Royal Hospital. The first and second doses of COVID-19 vaccinations (Pfizer BioNTech BNT162b2 or Oxford AstraZeneca ChAdOx1 nCoV-19) were administered to this patient coh...

Clinical Kidney Journal, 2022

Uro, 2022

Urolithiasis has become more prevalent in recent years, given the rapid rise of the global geriat... more Urolithiasis has become more prevalent in recent years, given the rapid rise of the global geriatric population. Although factors such as ethnicity, dietary and fluid intake, co-morbidity status and age have been associated with increased incidence of urolithiasis, the links between frailty status and risks of developing urolithiasis are not yet known. In this commentary, we will explore the scale and significance of this relationship based on emerging evidence. We will review the plausible factors on how a more severe frailty status may be significantly associated with greater risks of developing urolithiasis. We will also discuss the strategies that may help to lower the incidence of urolithiasis in older and frail individuals. We hope our article will bring greater awareness on this issue and motivate further research initiatives evaluating the relationship between frailty and urolithiasis, as well as holistic prevention strategies to lower the risks of developing urolithiasis wi...

World Journal of Transplantation, 2021

The primary aim of World Journal of Transplantation (WJT, World J Transplant) is to provide schol... more The primary aim of World Journal of Transplantation (WJT, World J Transplant) is to provide scholars and readers from various fields of transplantation with a platform to publish high-quality basic and clinical research articles and communicate their research findings online. WJT mainly publishes articles reporting research results obtained in the field of transplantation and covering a wide range of topics including bone transplantation, brain tissue transplantation, corneal transplantation, descemet stripping endothelial keratoplasty, fetal tissue transplantation, heart transplantation, kidney transplantation, liver transplantation, lung transplantation, pancreas transplantation, skin transplantation, etc..

Vaccines, 2021

Introduction: The introduction of COVID-19 vaccination programs has become an integral part of th... more Introduction: The introduction of COVID-19 vaccination programs has become an integral part of the major strategy to reduce COVID-19 numbers worldwide. New-onset and relapsed kidney histopathology have been reported following COVID-19 vaccination, sparking debate on whether there are causal associations. How these vaccines achieve an immune response to COVID-19 and the mechanism that this triggers kidney pathology remains unestablished. We describe the results of a systematic review for new-onset and relapsed kidney histopathology following COVID-19 vaccination. Methods: A systematic literature search of published data up until 31 August 2021 was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline. Research articles reporting new onset or relapsed kidney histopathology in adult patients (>18 years) following COVID-19 vaccination were included for qualitative review. Only full-text articles published in the English language w...

International Urology and Nephrology, 2021

Purpose People living with chronic kidney disease (CKD) are at a higher risk of hip fracture with... more Purpose People living with chronic kidney disease (CKD) are at a higher risk of hip fracture with an associated increased mortality risk compared to individuals without CKD. Our study aimed to evaluate the clinical assessment tools that best predict mortality risk following hip fracture for patients with CKD. Methods Patients with CKD G3b-5D admitted to Lancashire Teaching Hospitals NHS Foundation Trust, U.K. between June 2013 and Dec 2019 were included. The association between CKD and post-fracture mortality risk was evaluated. All patients were assessed using tools that evaluated frailty status, co-morbidity, pre-operative risk, functional status and cardiopulmonary fitness. Receiver operating characteristic curve analyses were performed to determine the prognostic accuracy of the assessment tools for 30 day and 1 year mortality following hip fracture in patients with CKD. Results 397 patients fulfilled inclusion criteria with a mean age of 83.5 ± 9.2 years. Older age, female sex,...

Case Reports in Nephrology and Dialysis, 2021

Anti-glomerular basement membrane (anti-GBM) disease is a rare form of small-vessel vasculitis th... more Anti-glomerular basement membrane (anti-GBM) disease is a rare form of small-vessel vasculitis that typically causes rapidly progressive glomerulonephritis with or without alveolar haemorrhage. Previously, there has only been one reported case of tumour necrosis factor-α (TNF-α) antagonist-induced anti-GBM disease. Here, we describe the first reported case of etanercept-induced anti-GBM disease. A 55-year-old Caucasian man was referred to our tertiary specialist renal centre with a history of painless macroscopic haematuria. The patient has been receiving weekly etanercept injections over the past 12 months for psoriatic arthropathy. The serum immunology panel results highlighted a significantly raised anti-GBM titre (370.1 U). Etanercept was stopped, and the patient was empirically commenced on pulsed methylprednisolone, cyclophosphamide, and plasma exchange. A renal biopsy showed crescentic glomerulonephritis. Few days after admission, he tested positive for coronavirus disease 20...

Introduction: The introduction of COVID-19 vaccination programs has become an integral part of th... more Introduction: The introduction of COVID-19 vaccination programs has become an integral part of the major strategy to reduce COVID-19 numbers worldwide. New-onset and relapsed kidney disease have been reported following COVID-19 vaccination, sparking debate on whether there are causal associations. How these vaccines achieve an immune response to COVID-19 and the mechanism in turn of how this triggers kidney pathology remains unestablished. We describe the results of a systematic review for new-onset and relapsed kidney disease following COVID-19 vaccination. Methods: A systematic literature search of published data up until 31st August 2021 was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline. Research articles reporting new onset or relapsed kidney disease in adult patients (>18 years) following COVID-19 vaccination were included for qualitative review. Only full-text articles published in the English language were selec...

Clinical Kidney Journal, 2021

Children, 2021

Introduction: COVID-19 infections resulting in pathological kidney manifestations have frequently... more Introduction: COVID-19 infections resulting in pathological kidney manifestations have frequently been reported in adults since the onset of the global COVID-19 pandemic in December 2019. Gradually, there have been an increased number of COVID-19-associated intrinsic kidney pathologies in children and adolescents reported as well. The pathophysiological mechanisms between COVID-19 and the onset of kidney pathology are not fully known in children; it remains a challenge to distinguish between intrinsic kidney pathologies that were caused directly by COVID-19 viral invasion, and cases which occurred as a result of multisystem inflammatory syndrome due to the infection. This challenge is made more difficult in children, due to the ethical limitations of performing kidney biopsies to reach a biopsy-proven diagnosis. Although previous systematic reviews have summarized the various pathological kidney manifestations that have occurred in adults following acute COVID-19 infection, such rev...

Hemodialysis International

An increasing demand for in-center dialysis services has been largely driven by a rapid growth of... more An increasing demand for in-center dialysis services has been largely driven by a rapid growth of the older population progressing to end-stage kidney disease. Since the onset of the COVID-19 pandemic, efforts to encourage homebased dialysis options have increased due to risks of infective transmission for patients receiving hemodialysis in center-based units. There are various practical and clinical advantages for patients receiving hemodialysis at home. However, the lack of caregiver support, cognitive and physical impairment, challenges of vascular access, and preparation and training for home hemodialysis (HHD) initiation may present as barriers to successful implementation of HHD in the older dialysis population. Assessment of an older patient's frailty status may help clinicians guide patients when making decisions about HHD. The development of an assisted HHD care delivery model and advancement of telehealth and technology in provision of HHD care may increase accessibility of HHD services for older patients. This review examines these factors and explores current unmet needs and barriers to increasing access, inclusion, and opportunities of HHD for the older dialysis population.

Clinical Kidney Journal

There is a rising demand for dialysis in the older population given the increased numbers of olde... more There is a rising demand for dialysis in the older population given the increased numbers of older adults living with chronic kidney disease (CKD) progressing to kidney failure. Home dialysis, i.e. peritoneal dialysis (PD) and home hemodialysis (HHD), has been available for decades, but more recently there has been a rapid increase in home dialysis utilization as patients and clinicians consider its practical and clinical advantages. For older adults, incident home dialysis utilization more than doubled and prevalent home dialysis growth nearly doubled over the past decade. Whilst its advantages and recent rise in popularity are evident, there are numerous barriers and challenges that are important to consider prior to initiating older adults on home dialysis. Some nephrology healthcare professionals do not view home dialysis as an option for older adults. Successful delivery of home dialysis for older adults may be made even more difficult by physical or cognitive limitations, conc...

Rheumatology Advances in Practice

Children

Global COVID-19 vaccination programs for children and adolescents have been developed with intern... more Global COVID-19 vaccination programs for children and adolescents have been developed with international clinical trial data confirming COVID-19 mRNA vaccine safety and efficacy for the pediatric population. The impact of COVID-19 vaccination in the kidneys is thought to be explained by a complex immune-mediated relationship between the two, although the pathophysiological mechanisms of how COVID-19 vaccination potentially induces kidney pathology are not presently well known. Whilst intrinsic kidney pathologies following COVID-19 vaccination have been reported in adults, such cases are only being recently reported with greater frequency in children and adolescents. Conforming to the PRISMA checklist, we conducted a systematic review of the current literature to provide an overview on the range of intrinsic kidney pathologies that have been reported following COVID-19 vaccination in children and adolescents. All English language research articles published on or before 30 June 2022 ...

Allergies

Chronic kidney disease-associated pruritus (CKDaP) is an often under-diagnosed and under-recogniz... more Chronic kidney disease-associated pruritus (CKDaP) is an often under-diagnosed and under-recognized condition, despite its considerable prevalence within the chronic kidney disease (CKD) population. Universally accepted guidelines are also lacking. The true prevalence of CKDaP worldwide therefore remains unknown, although its negative impact on mortality and health-related quality of life outcomes is very clear. The pathophysiological mechanisms leading to the onset of CKDaP are only partly understood. CKDaP is currently believed to be caused by a multifactorial process, from local skin changes, metabolic alterations, the development of neuropathy and dysregulation of opioid pathways, and psychological factors. Much work has been carried out towards a more systematic and structured approach to clinical diagnosis. Various tools are now available to assess the severity of CKDaP. Many of these tools require greater validation before they can be incorporated into the guidelines and into...

Kidney and Dialysis

Anemia in chronic kidney disease (CKD) has become an important clinical issue with the increased ... more Anemia in chronic kidney disease (CKD) has become an important clinical issue with the increased prevalence of elderly patients living with CKD progressing to kidney failure. The causes of anemia in elderly individuals tend to be multifactorial, exacerbated by the physiological effects of aging, frailty and declining kidney function. Erythropoiesis-stimulating agents (ESAs) are the conventional therapeutic option for anemia in CKD. However, ESA hyporesponsiveness is a commonly observed issue in clinical practice and an issue that is more challenging to resolve in elderly patients living with frailty, kidney disease, and multi-morbidities. Following the emergence of oral hypoxia-induced factor prolyl-hydroxylase inhibitors (HIF-PHI) in recent years, there is discussion on whether it is a solution to the conundrum of ESA hyporesponsiveness, as HIF-PHI treats anemia via an alternative physiological pathway. There remains uncertainty on the suitability of HIF-PHI use in elderly patients...

International Journal of Molecular Sciences

Chronic kidney disease (CKD) is a global health issue, affecting more than 10% of the worldwide p... more Chronic kidney disease (CKD) is a global health issue, affecting more than 10% of the worldwide population. The current approach for formal diagnosis and prognostication of CKD typically relies on non-invasive serum and urine biomarkers such as serum creatinine and albuminuria. However, histological evidence of tubulointerstitial fibrosis is the ‘gold standard’ marker of the likelihood of disease progression. The development of novel biomedical technologies to evaluate exfoliated kidney cells from urine for non-invasive diagnosis and prognostication of CKD presents opportunities to avoid kidney biopsy for the purpose of prognostication. Efforts to apply these technologies more widely in clinical practice are encouraged, given their potential as a cost-effective approach, and no risk of post-biopsy complications such as bleeding, pain and hospitalization. The identification of biomarkers in exfoliated kidney cells from urine via western blotting, enzyme-linked immunosorbent assay (EL...

Vaccines, 2022

Background: The advancement of COVID-19 vaccination programs globally has been viewed as an integ... more Background: The advancement of COVID-19 vaccination programs globally has been viewed as an integral strategy to reduce both the number of COVID-19 cases and consequential complications of COVID-19, particularly for high-risk patient groups. There are limited data on the antibody response and protection from disease infection and severity in patients requiring hemodialysis (HD) following COVID-19 vaccination during the Delta and Omicron variant predominance. We conducted a study aiming to evaluate humoral immunity derived from two different COVID-19 vaccines administered to our in-centre HD population and investigated the characteristics of breakthrough COVID-19 infections occurring post-vaccination within this population. Methods: This is a prospective observational study including patients receiving HD at Salford Royal Hospital. The first and second doses of COVID-19 vaccinations (Pfizer BioNTech BNT162b2 or Oxford AstraZeneca ChAdOx1 nCoV-19) were administered to this patient coh...

Clinical Kidney Journal, 2022

Uro, 2022

Urolithiasis has become more prevalent in recent years, given the rapid rise of the global geriat... more Urolithiasis has become more prevalent in recent years, given the rapid rise of the global geriatric population. Although factors such as ethnicity, dietary and fluid intake, co-morbidity status and age have been associated with increased incidence of urolithiasis, the links between frailty status and risks of developing urolithiasis are not yet known. In this commentary, we will explore the scale and significance of this relationship based on emerging evidence. We will review the plausible factors on how a more severe frailty status may be significantly associated with greater risks of developing urolithiasis. We will also discuss the strategies that may help to lower the incidence of urolithiasis in older and frail individuals. We hope our article will bring greater awareness on this issue and motivate further research initiatives evaluating the relationship between frailty and urolithiasis, as well as holistic prevention strategies to lower the risks of developing urolithiasis wi...

World Journal of Transplantation, 2021

The primary aim of World Journal of Transplantation (WJT, World J Transplant) is to provide schol... more The primary aim of World Journal of Transplantation (WJT, World J Transplant) is to provide scholars and readers from various fields of transplantation with a platform to publish high-quality basic and clinical research articles and communicate their research findings online. WJT mainly publishes articles reporting research results obtained in the field of transplantation and covering a wide range of topics including bone transplantation, brain tissue transplantation, corneal transplantation, descemet stripping endothelial keratoplasty, fetal tissue transplantation, heart transplantation, kidney transplantation, liver transplantation, lung transplantation, pancreas transplantation, skin transplantation, etc..

Vaccines, 2021

Introduction: The introduction of COVID-19 vaccination programs has become an integral part of th... more Introduction: The introduction of COVID-19 vaccination programs has become an integral part of the major strategy to reduce COVID-19 numbers worldwide. New-onset and relapsed kidney histopathology have been reported following COVID-19 vaccination, sparking debate on whether there are causal associations. How these vaccines achieve an immune response to COVID-19 and the mechanism that this triggers kidney pathology remains unestablished. We describe the results of a systematic review for new-onset and relapsed kidney histopathology following COVID-19 vaccination. Methods: A systematic literature search of published data up until 31 August 2021 was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline. Research articles reporting new onset or relapsed kidney histopathology in adult patients (>18 years) following COVID-19 vaccination were included for qualitative review. Only full-text articles published in the English language w...

International Urology and Nephrology, 2021

Purpose People living with chronic kidney disease (CKD) are at a higher risk of hip fracture with... more Purpose People living with chronic kidney disease (CKD) are at a higher risk of hip fracture with an associated increased mortality risk compared to individuals without CKD. Our study aimed to evaluate the clinical assessment tools that best predict mortality risk following hip fracture for patients with CKD. Methods Patients with CKD G3b-5D admitted to Lancashire Teaching Hospitals NHS Foundation Trust, U.K. between June 2013 and Dec 2019 were included. The association between CKD and post-fracture mortality risk was evaluated. All patients were assessed using tools that evaluated frailty status, co-morbidity, pre-operative risk, functional status and cardiopulmonary fitness. Receiver operating characteristic curve analyses were performed to determine the prognostic accuracy of the assessment tools for 30 day and 1 year mortality following hip fracture in patients with CKD. Results 397 patients fulfilled inclusion criteria with a mean age of 83.5 ± 9.2 years. Older age, female sex,...

Case Reports in Nephrology and Dialysis, 2021

Anti-glomerular basement membrane (anti-GBM) disease is a rare form of small-vessel vasculitis th... more Anti-glomerular basement membrane (anti-GBM) disease is a rare form of small-vessel vasculitis that typically causes rapidly progressive glomerulonephritis with or without alveolar haemorrhage. Previously, there has only been one reported case of tumour necrosis factor-α (TNF-α) antagonist-induced anti-GBM disease. Here, we describe the first reported case of etanercept-induced anti-GBM disease. A 55-year-old Caucasian man was referred to our tertiary specialist renal centre with a history of painless macroscopic haematuria. The patient has been receiving weekly etanercept injections over the past 12 months for psoriatic arthropathy. The serum immunology panel results highlighted a significantly raised anti-GBM titre (370.1 U). Etanercept was stopped, and the patient was empirically commenced on pulsed methylprednisolone, cyclophosphamide, and plasma exchange. A renal biopsy showed crescentic glomerulonephritis. Few days after admission, he tested positive for coronavirus disease 20...

Introduction: The introduction of COVID-19 vaccination programs has become an integral part of th... more Introduction: The introduction of COVID-19 vaccination programs has become an integral part of the major strategy to reduce COVID-19 numbers worldwide. New-onset and relapsed kidney disease have been reported following COVID-19 vaccination, sparking debate on whether there are causal associations. How these vaccines achieve an immune response to COVID-19 and the mechanism in turn of how this triggers kidney pathology remains unestablished. We describe the results of a systematic review for new-onset and relapsed kidney disease following COVID-19 vaccination. Methods: A systematic literature search of published data up until 31st August 2021 was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline. Research articles reporting new onset or relapsed kidney disease in adult patients (>18 years) following COVID-19 vaccination were included for qualitative review. Only full-text articles published in the English language were selec...

Clinical Kidney Journal, 2021

Children, 2021

Introduction: COVID-19 infections resulting in pathological kidney manifestations have frequently... more Introduction: COVID-19 infections resulting in pathological kidney manifestations have frequently been reported in adults since the onset of the global COVID-19 pandemic in December 2019. Gradually, there have been an increased number of COVID-19-associated intrinsic kidney pathologies in children and adolescents reported as well. The pathophysiological mechanisms between COVID-19 and the onset of kidney pathology are not fully known in children; it remains a challenge to distinguish between intrinsic kidney pathologies that were caused directly by COVID-19 viral invasion, and cases which occurred as a result of multisystem inflammatory syndrome due to the infection. This challenge is made more difficult in children, due to the ethical limitations of performing kidney biopsies to reach a biopsy-proven diagnosis. Although previous systematic reviews have summarized the various pathological kidney manifestations that have occurred in adults following acute COVID-19 infection, such rev...