This non-interventional, observational study retrospectively (and in parts prospectively) investigates, if a Covid-19 associated Nephritis, diagnosed by Urine-dipstick and further Urine-analyses on addmission, can help to predict later complications, adverse outcomes and later need for ICU-capacity in Covid-19 patients as well as can guide preventive strategies.
Parameters predicting risks for Covid-19 patients are urgently sought. The current study
investigates, if Covid-19 associated nephritis indicating systemic cappillary leak
syndrome/severe nephrotic syndrome could be the major driver for complications, predictor for
respiratory failure and later need for ICU, and death.
This study intends to generate an algorithm for University hospitals, which allows early
detection of Covid-19 associated nephritis and to classify the risk for respiratory
decompensation by quantification of severity of nephrotic syndrome.
The rationale of the observational study can be explained by the hypothesis that Covid-19
causes Nephritis: Podocytes express high levels of ACE2, which makes the glomerulus to a
target for Covid-19. Other zoonoses, such as Hanta-virus, are a well described cause of
nephrotic syndrome inducing cardiopulmonary syndrome. Life-threatening complications of
severe nephrotic syndrome are well known as are preventive therapies.
Covid-19 ICU patients with nephritis have
1. pulmonary interstitial edema, possibly also due to capillary leak/ nephrotic syndrome;
2. immune-incompetence, due to renal loss of immunoglobulins;
3. circulatory insufficiency, due to hypalbuminemia (which might explain sudden deaths in
the geriatric population);
4. less response to some medications caused by impaired plasma protein binding of drugs due
to hypalbuminemia and renal loss;
5. thromboembolic events, due to antithrombin-deficiency (which might explain lethality in
oligo-symptomatic young patients).
In conclusion, ACE2 in the respiratory tract is the gateway for Covid-19 for infection,
however, the study postulates that Covid-19 associated nephritis and severe cappillary
leak/nephrotic syndrome is a major driver of adverse outcome. If confirmed by others, these
findings and algorithm would allow early prediction of later need for ICU-capacity, better
allocation of patients for clinical trials, and preventive strategies focused on the
nephrotic syndrome including treatment, which can save lives. Same might apply for
risk-evaluation of outpatients.
Inclusion Criteria:
1. approved Covid-19 diagnosis (by PCR or CT-scan);
2. urine status during hospital stay
3. Patient expressed willingness to participate in observational studies during hospital
admission.
Exclusion Criteria:
1) Patient expressed unwillingness to participate in observational studies during hospital
admission.
University Medical Center Goettingen
Göttingen, Germany