Shrunken Pore Syndrome Is Frequently Occurring in Severe COVID-19

Abstract

A selective decrease in the renal filtration of larger molecules is attributed to the shrinkage of glomerular pores, a condition termed Shrunken Pore Syndrome (SPS). SPS is associated with poor long-term prognosis. We studied SPS as a risk marker in a cohort of patients with COVID-19 treated in an intensive care unit. SPS was defined as a ratio < 0.7 when the estimated glomerular filtration rate (eGFR), determined by cystatin C, calculated by the Cystatin C Caucasian-Asian-Pediatric-Adult equation (CAPA), was divided by the eGFR determined by creatinine, calculated by the revised Lund–Malmö creatinine equation (LMR). Clinical data were prospectively collected. In total, SPS was present in 86 (24%) of 352 patients with COVID-19 on ICU admission. Patients with SPS had a higher BMI, Simplified Physiology Score (SAPS3), and had diabetes and/or hypertension more frequently than patients without SPS. Ninety-nine patients in the total cohort were women, 50 of whom had SPS. In dexamethasone-naïve patients, C-reactive protein (CRP ), TNF-alpha, and interleukin-6 did not differ between SPS and non-SPS patients. Demographic factors (gender, BMI) and illness severity (SAPS3) were independent predictors of SPS. Age and dexamethasone treatment did not affect the frequency of SPS after adjustments for age, sex, BMI, and acute severity. SPS is frequent in severely ill COVID-19 patients. Female gender was associated with a higher proportion of SPS. Demographic factors and illness severity were independent predictors of SPS.

eGFRcystatinC/eGFRcreatinine ratio < 0.6 in patients with SARS-CoV-2 pneumonia: a prospective cohort study

“…First, other previously published study by Larsson AO et al [ 9 ] has also used estimated GFR in critically ill COVID-19 patients to determine eGFR by cystatin C (Caucasian-Asian-Pediatric-Adult equation -CAPA), and Lund–Malmö creatinine equation (LMR) to calculate eGFR determined by creatinine. Neither of formulas have been approved for use in AKI.…”

“…The studies carried out so far have mainly focused on outpatient cohorts, yielding results that the prevalence of this phenomenon ranged from 0.7 to 22.3% [ 2 – 7 ]. The only study so far with SARS-CoV-2 infected patients admitted to intensive care unit shows prevalence of 24% [ 9 ]. In our study 38.6% of patients had low-GFR cys /GFR cr , which is significantly higher than described before.…”

“…Regardless of the unclear mechanisms that lead to the phenomenon of a changed quality of kidney filtration, the importance of low-GFR cys /GFR cr reflects in the emerging large-scale studies on the subject, and only one of those studies has described SPS in SARS-CoV-2 infection [ 9 ].…”

Coronavirus Disease Pathophysiology: Biomarkers, Potential New Remedies, Comorbidities, Long COVID-19, Post Pandemic Epidemiological Surveillance

“…The group of Anders Larsson [13] studied Shrunken Pore Syndrome (SPS) as a risk marker for COVID-19 patients. SPS is a condition when a selective decrease in the renal filtration of larger molecules is observed.…”