tetano
Editor, Senior Moderator
Clin J Am Soc Nephrol
. 2021 Feb 23;CJN.09130620.
doi: 10.2215/CJN.09130620. Online ahead of print.
Proteinuria and Clinical Outcomes in Hospitalized COVID-19 Patients: A Retrospective Single-Center Study
Alexandre Karras[SUP] 1 2 [/SUP], Marine Livrozet[SUP] 2 3 [/SUP], H?l?ne Lazareth[SUP] 4 2 [/SUP], Nicolas Benichou[SUP] 4 2 [/SUP], Jean-S?bastien Hulot[SUP] 2 3 [/SUP], Antoine Fayol[SUP] 2 3 [/SUP], Sophie Chauvet[SUP] 4 2 [/SUP], Anne-Sophie Jannot[SUP] 2 5 [/SUP], Marie-Aude Penet[SUP] 2 6 [/SUP], Jean-Luc Diehl[SUP] 2 7 [/SUP], Anne Godier[SUP] 2 8 [/SUP], Olivier Sanchez[SUP] 2 9 [/SUP], Tristan Mirault[SUP] 2 10 [/SUP], Eric Thervet[SUP] 4 2 [/SUP], Nicolas Pallet[SUP] 2 11 [/SUP]
Affiliations
Abstract
Background and objectives: Kidney involvement is frequent among patients with coronavirus disease 2019 (COVID-19), and occurrence of AKI is associated with higher mortality in this population. The objective of this study was to describe occurrence and significance of proteinuria in this setting. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS : We conducted a single-center retrospective study to describe the characteristic features of proteinuria measured within 48 hours following admission among patients with COVID-19 admitted in a tertiary care hospital in France, and to evaluate its association with initiation of dialysis, intensive care unit admission, and death.
Results: Among 200 patients with available data, urine protein-creatinine ratio at admission was ≥1 g/g for 84 (42%), although kidney function was normal in most patients, with a median serum creatinine of 0.94 mg/dl (interquartile range, 0.75-1.21). Median urine albumin-creatinine ratio was 110 mg/g (interquartile range, 50-410), with a urine albumin-protein ratio <50% in 92% of patients. Urine retinol binding protein concentrations, available for 85 patients, were ≥0.03 mg/mmol in 62% of patients. Urine protein-creatinine ratio ≥1 g/g was associated with initiation of dialysis (odds ratio, 4.87; 95% confidence interval, 2.03 to 13.0; P<0.001), admission to the intensive care unit (odds ratio, 3.55; 95% confidence interval, 1.93 to 6.71; P<0.001), and death (odds ratio, 3.56; 95% confidence interval, 1.90 to 6.54; P<0.001).
Conclusions: Proteinuria is very frequent among patients admitted for COVID-19 and may precede AKI. Low levels of albuminuria suggest a predominant tubular origin, confirmed by the elevated levels of urine retinol binding protein. Urine protein-creatinine ratio ≥1 g/g at admission is strongly associated with poor kidney and patient outcome.
Keywords: COVID-19; acute renal failure; prognosis; proteinuria; proximal tubule; tubular epithelium.
. 2021 Feb 23;CJN.09130620.
doi: 10.2215/CJN.09130620. Online ahead of print.
Proteinuria and Clinical Outcomes in Hospitalized COVID-19 Patients: A Retrospective Single-Center Study
Alexandre Karras[SUP] 1 2 [/SUP], Marine Livrozet[SUP] 2 3 [/SUP], H?l?ne Lazareth[SUP] 4 2 [/SUP], Nicolas Benichou[SUP] 4 2 [/SUP], Jean-S?bastien Hulot[SUP] 2 3 [/SUP], Antoine Fayol[SUP] 2 3 [/SUP], Sophie Chauvet[SUP] 4 2 [/SUP], Anne-Sophie Jannot[SUP] 2 5 [/SUP], Marie-Aude Penet[SUP] 2 6 [/SUP], Jean-Luc Diehl[SUP] 2 7 [/SUP], Anne Godier[SUP] 2 8 [/SUP], Olivier Sanchez[SUP] 2 9 [/SUP], Tristan Mirault[SUP] 2 10 [/SUP], Eric Thervet[SUP] 4 2 [/SUP], Nicolas Pallet[SUP] 2 11 [/SUP]
Affiliations
- PMID: 33661756
- DOI: 10.2215/CJN.09130620
Abstract
Background and objectives: Kidney involvement is frequent among patients with coronavirus disease 2019 (COVID-19), and occurrence of AKI is associated with higher mortality in this population. The objective of this study was to describe occurrence and significance of proteinuria in this setting. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS : We conducted a single-center retrospective study to describe the characteristic features of proteinuria measured within 48 hours following admission among patients with COVID-19 admitted in a tertiary care hospital in France, and to evaluate its association with initiation of dialysis, intensive care unit admission, and death.
Results: Among 200 patients with available data, urine protein-creatinine ratio at admission was ≥1 g/g for 84 (42%), although kidney function was normal in most patients, with a median serum creatinine of 0.94 mg/dl (interquartile range, 0.75-1.21). Median urine albumin-creatinine ratio was 110 mg/g (interquartile range, 50-410), with a urine albumin-protein ratio <50% in 92% of patients. Urine retinol binding protein concentrations, available for 85 patients, were ≥0.03 mg/mmol in 62% of patients. Urine protein-creatinine ratio ≥1 g/g was associated with initiation of dialysis (odds ratio, 4.87; 95% confidence interval, 2.03 to 13.0; P<0.001), admission to the intensive care unit (odds ratio, 3.55; 95% confidence interval, 1.93 to 6.71; P<0.001), and death (odds ratio, 3.56; 95% confidence interval, 1.90 to 6.54; P<0.001).
Conclusions: Proteinuria is very frequent among patients admitted for COVID-19 and may precede AKI. Low levels of albuminuria suggest a predominant tubular origin, confirmed by the elevated levels of urine retinol binding protein. Urine protein-creatinine ratio ≥1 g/g at admission is strongly associated with poor kidney and patient outcome.
Keywords: COVID-19; acute renal failure; prognosis; proteinuria; proximal tubule; tubular epithelium.