Analysis of early renal injury in COVID-19 and diagnostic value of multi-index combined detection

Xu-wei Hong; Ze-pai Chi; Guo-yuan Liu; Hong Huang; Shun-qi Guo; Jing-ru Fan; Xian-wei Lin; Liao-zhun Qu; Rui-lie Chen; Ling-jie Wu; Liang-yu Wang; Qi-chuan Zhang; Su-wu Wu; Ze-qun Pan; Hao Lin; Yu-hua Zhou; Yong-hai Zhang

The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.03.07.20032599 doi: medRxiv preprint coronaviruses (SARSr-CoV). In addition, they also confirmed that 2019-nCov used the same cell entry receptor, Angiotensin converting enzyme II (ACE2), as SARS-CoV. The high degree of similarity in gene sequence and cellular mechanism of 2019-nCoV and SARS-CoV suggests that the risk factors of mortality could also be similar. SARS is an acute respiratory infectious disease with pulmonary parenchyma and/or interstitium as the main site of invasion and multiple organ injury. Previous clinical studies have found that, similar to SARS, the causes of death caused by 2019-nCov are not only lung tissue damage, but also heart, liver, kidney and other organ dysfunction or even failure, which is one of the important causes of aggravation and death. [8, 9] In the previous SARS case study [12] , acute renal injury was found to be the top risk factor of mortality, even higher than acute respiratory distress. In that case study, all patients who eventually died had a progressive rise of Scr, and the rise of Scr was rapid in those who succumbed early in their illness. Previously, an ongoing case study reported 59 patients infected by 2019-nCoV, including 28 severe cases and 3 death. In that study, 63% of the patients exhibited proteinuria, and 19% and 27% of the patients had an elevated level of Scr and BUN respectively. Computed tomography (CT) scans revealed abnormal renal imaging in all patients. The results suggested that renal injury was common in COVID-19, which may contribute to multiorgan failure and death eventually. [13] In this study, 12 COVID-19 cases were analyzed. Although all the patients still had normal level of Scr and BUN, the high incidence of early renal injury in COVID-19 was found by calculating eGFR, CCR and UACR. The abnormal rates of eGFR, Ccr, and UACR were 66.7%, 41.7%, and 41.7%, respectively. Combined detection of UMA, A1M, IGU, and TRU could be helpful for the diagnosis of early renal injury in COVID-19. Furthermore, the study also found that the degree of early renal injury was significantly related to C-reactive protein (CRP) and neutrophil ratio (NER), suggesting that the more severe the infection, the more obvious the early renal injury. Hypokalemia and hyponatremia were common in patients with COVID-19, and there was a correlation with the degree of renal injury. Xin Zou et al [14] analyzed All rights reserved. No reuse allowed without permission.