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Marco Giuseppe Migliaccio,1,* Marco Di Mauro,1,* Riccardo Ricciolino,1 Giorgio Spiniello,1 Vincenzo Carfora,1 Nicoletta Verde,1 Filiberto Fausto Mottola,1 Nicola Coppola2 On behalf of the Vanvitelli COVID-19 Group1Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy; 2Department of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy*These authors contributed equally to this workCorrespondence: Nicola CoppolaDepartment of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania “Luigi Vanvitelli”, Via: L. Armanni 5, Naples, 80131, ItalyTel +39 081 5666719Fax +39 081 5666013Email nicola.coppola@unicampania.itAbstract: Kidney injury may be a severe complication of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and contributes to worsen the prognosis. Various pathophysiological mechanisms can contribute to organ damage and impair renal function, proving the complexity of the virus activity and the resulting immunity response. We summarized the evidence of the literature on the prevalence of kidney involvement, on the pathogenic pathways and on its management.Keywords: kidney injury, acute kidney injury, COVID-19, SARS-CoV-2

The actual Coronavirus Disease (COVID 19) pandemic is due to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the coronavirus family. Besides the respiratory involvement, COVID 19 patients frequently develop a pro-coagulative state caused by virus-induced endothelial dysfunction, cytokine storm and complement cascade hyperactivation. It is common to observe diffuse microvascular thrombi in multiple organs, mostly in pulmonary microvessels. Thrombotic risk seems to be directly related to disease severity and worsens patients’ prognosis. Therefore, the correct understanding of the mechanisms underlying COVID-19 induced prothrombotic state can lead to a thorough assessment of the possible management strategies. Hence, we review the pathogenesis and therapy of COVID 19-related thrombosis disease, focusing on the available evidence on the possible treatment strategies and proposing an algorithm for the anticoagulation strategy based on disease severity.