Urinary SARS-CoV-2 RNA is An Indicator For The Progression and Prognosis of COVID-19 Disease

Abstract

Background: We aimed to analyse clinical characteristics and find potential factors predicting poor prognosis in patients with coronavirus disease 2019 (COVID-19). Methods: We analyzed the demographic and clinical data of COVID-19 patients and detected SARS-CoV-2 RNA in urine sediments collected from 53 COVID-19 patients enrolled in Renmin Hospital of Wuhan University from January 31, 2020 to February 18, 2020 with qRT-PCR analysis, and then classified those patients based on clinical conditions (severe or non-severe syndrome) and urinary SARS-CoV-2 RNA (URNA- or URNA+). Results: We found that COVID-19 patients with severe syndrome (severe patients) showed significantly higher positive rate (11 of 23, 47.8%) of urinary SARS-CoV-2 RNA than non-severe patients (4 of 30, 13.3%, p = 0.006). URNA+ patients or severe URNA+ subgroup exhibited higher prevalence of inflammation and immune discord, cardiovascular diseases, liver damage and renal disfunction, and higher risk of death than URNA- patients. To understand the potential mechanisms underlying the viral urine shedding, we performed renal histopathological analysis on postmortems of patients with COVID-19 and found that severe renal vascular endothelium lesion characterized by increase of the expression of thrombomodulin and von Willebrand factor, markers to assess the endothelium dysfunction. We proposed a theoretical and mathematic model to depict the potential factors determining the urine shedding of SARS-CoV-2. Conclusions: This study indicated that urinary SARS-CoV-2 RNA detected in urine specimens can be used to predict the progression and prognosis of COVID-19 severity.

Detection of SARS-CoV-2 RNA in Urine by RT-LAMP: A Very Rare Finding

“…Additionally, the few methodologically sound studies using RT-qPCR for detection included a small number of specimens and found a very low rate of positivity [ 14 ]. On the other hand, there are still conflicting opinions as to whether the presence of the virus in urine can be an indicator of severity or worse prognosis of the disease [ 15 , 16 , 17 , 18 , 19 ].…”

COVID-19 associated lower urinary tract symptoms in children

“…Despite the identical pattern, onset and duration was variable in each patient with no relation between intensity of symptoms and duration or timing of onset. Tian et al showed urine shedding of SARS-COV-2 in 38 of the 52 COVID patients [10]. Viral load in urine might be an explanation for the symptoms.…”

“…Tian et al showed urine shedding of SARS-COV-2 in 38 of the 52 COVID patients[ 10 ]. Viral load in urine might be an explanation for the symptoms.…”

“…Current studies also support this. In the study by Tian et al, patients with urine shedding had worse renal function and clinical outcome[ 10 ]. They attributed this relation to a higher viral load or presence of a new or preexisting endothelial damage in those patients.…”