Proteinuria as a Biomarker for COVID-19 Severity

Abstract

BackgroundRenal involvement in syndrome coronavirus 2 (SARS-CoV-2) infection has been retrospectively described, especially acute kidney injury (AKI). However, quantitative proteinuria assessment and its implication in coronavirus disease 2019 (COVID-19) remain unknown.MethodsIn this prospective, multicenter study in France, we collected clinical and biological data including urinary protein to creatine ratio (UPCR) in patients presenting with moderate to severe COVID-19. Clinical outcome was analyzed according to the level of UPCR.Results42/45 patients (93.3%) had renal involvement (abnormal urinary sediment and/or AKI). Significant proteinuria occurred in 60% of patients. Urine protein electrophoresis showed tubular protein excretion in 83.8% of patients with proteinuria. Inflammatory parametersand D-dimer concentrations correlated with proteinuria level. Patients who required intensive care unit (ICU) admission had higher proteinuria (p = 0.008). On multivariate analysis, proteinuria greater than 0.3 g/g was related to a higher prevalence of ICU admission [OR = 4.72, IC95 (1.16–23.21), p = 0.03], acute respiratory distress syndrome (ARDS) [OR = 6.89, IC95 (1.41–53.01, p = 0.02)], nosocomial infections [OR = 3.75, IC95 (1.11–13.55), p = 0.03], longer inpatient hospital stay (p = 0.003).ConclusionRenal involvement is common in moderate to severe SARS-CoV-2 infection. Proteinuria at baseline is an independent risk factor for increased hospitalization duration and ICU admission in patients with COVID-19.

Urine sediment findings were milder in patients with COVID-19-associated renal injuries than in those with non-COVID-19-associated renal injuries

“…Urinalysis and urine sediment examinations are the oldest and most commonly performed tests for assessing the pathophysiological condition of the kidney/urethral system. Urinalysis findings, such as proteinuria, hematuria, and leukocyturia, are reportedly associated with COVID-19-associated renal injuries and the severity of COVID-19 (Allemailem et al, 2021, Chan et al, 2020, Ouahmi et al, 2021, Pei et al, 2020, Yang et al, 2020, and several urinary chemical biomarkers, such as N-acetyl-β-D-glucosaminidase (NAG), α1-microglobulin (α1-MG), and neutrophil gelatinase-associated lipocalin (NGAL), have been proposed to be associated with AKI in hospitalized COVID-19 patients (Fukao et al, 2021, Huart et al, 2021, Husain-Syed et al, 2020, Luther et al, 2021. However, the characteristics of the urine sediment findings related to have not yet been studied adequately.…”

Can microalbuminuria be an ındicator of renal ınvolvement in pediatric Covid 19 patients?

“…Recent studies demonstrated that kidney involvement; particularly proteinuria is an important and independent predictor of outcome in SARS-CoV-2 infection [21,22,[25][26][27]. Ouahmi et al reported that proteinuria is related with increased length of stay and admission to intensive care unit (ICU) [21].…”

“…Recent studies demonstrated that kidney involvement; particularly proteinuria is an important and independent predictor of outcome in SARS-CoV-2 infection [21,22,[25][26][27]. Ouahmi et al reported that proteinuria is related with increased length of stay and admission to intensive care unit (ICU) [21]. Chaudhri et al stated that proteinuria at admission was associated with AKI during hospitalization; and proteinuria during hospitalization was associated with increased risk of death [18].…”

Long-Term Clinical and Immunological Impact of Severe COVID-19 on a Living Kidney Transplant Recipient – A Case Report

“…The patient’s kidney function was impaired during the acute progressive phase of COVID-19 with a markedly increased serum Cr level and decreased eGFR. Though his Cr level and eGFR eventually recovered to the normal level, the mechanism by which the SARS-CoV-2 virus impairs renal function remains unknown ( 16 , 17 ). Before his acute COVID-19 episode, he had never previously had detectable proteinuria in the 7-years since his living donor transplant.…”