COVID-19-associated nephritis: early warning for disease severity and complications?

SARS-CoV-2 uses the receptor ACE2 for cell entry, and podocytes express ACE2.1 Glomerular changes and nephritis-like histology have been described in postmortem samples from patients with COVID-19.2 Other zoonoses, such as some hantaviruses, cause nephrotic syndrome, which in turn induces cardiopulm...

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Veröffentlicht in:The Lancet (British edition) Jg. 395; H. 10236; S. e87 - e88
Hauptverfasser: Gross, Oliver, Moerer, Onnen, Weber, Manfred, Huber, Tobias B, Scheithauer, Simone
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Elsevier Ltd 16.05.2020
Elsevier Limited
Schlagworte:
ACE2
Angiotensin-converting enzyme 2
Antithrombin
Betacoronavirus
China
Clinical trials
Coronavirus Infections
Coronaviruses
COVID-19
Edema
Health risk assessment
Histology
Humans
Immunoglobulins
Nephritis
Nephrotic syndrome
Pandemics
Patients
Pneumonia, Viral
Respiratory tract
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Thromboembolism
Urine
Viral diseases
China
Germany
ISSN:0140-6736, 1474-547X, 1474-547X
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Zusammenfassung:SARS-CoV-2 uses the receptor ACE2 for cell entry, and podocytes express ACE2.1 Glomerular changes and nephritis-like histology have been described in postmortem samples from patients with COVID-19.2 Other zoonoses, such as some hantaviruses, cause nephrotic syndrome, which in turn induces cardiopulmonary syndrome.3,4 Complications of nephrotic syndrome are known to be similar to capillary leak syndrome, and preventive therapies are available.5 We recommend that patients with COVID-19 who have nephritis be carefully monitored for the following conditions: pulmonary interstitial oedema, due to severe fluid overload similar to nephrotic syndrome; immune incompetence, due to renal loss of immunoglobulins; circulatory insufficiency, due to hypalbuminaemia; poor drug response because of impaired plasma protein binding; and thromboembolic events due to antithrombin deficiency. In summary, the respiratory tract is the gateway for SARS-CoV-2 infection, but we postulate that COVID-19-associated nephritis, which can be easily screened for through a simple and inexpensive urine sample analysis, might help predict complications. If validated, we believe this tool could allow early anticipation of later need for ICU admission, improved allocation of patients for special therapies (eg, in clinical trials), and initiation of preventive strategies focused on capillary leak syndrome, including treatment that could save lives.
Bibliographie:SourceType-Scholarly Journals-1
ObjectType-Correspondence-1
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ObjectType-Commentary-2
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ISSN:0140-6736
1474-547X
1474-547X
DOI:10.1016/S0140-6736(20)31041-2