During COVID-19 inpatient treatment, the team of experts from the University Medical Center Goettingen noticed that the kidneys - in addition to the lungs and heart - are also affected at an early stage, especially in the most seriously ill patients. Urine analysis showed that significant abnormalities were already observed days before a rapid worsening of COVID-19 infection. In addition to the urine findings, albumin in urine and in blood as well as antithrombin III were used for the diagnosis of the capillary leak syndrome which can be a predictor of fluid overload and respiratory failure. Patients who developed a severe course of COVID-19 exhibited low antithrombin III concentrations, severe hypalbuminemia and positive results for blood, albumin and leukocytes in urine.
Based on these findings the experts of the University Medical Center of Goettingen generated an algorithm for early detection of COVID-19 associated nephritis and to assess the risk of respiratory decompensation by capillary leak syndrome. To confirm the results, a multicenter observational study (NCT04347824) was initiated in Germany. If validated, the instrument could enable early recognition of future needs for admission to intensive care units, improved allocation of patients for specific therapies and the initiation of preventive strategies focusing on capillary leakage syndrome, including treatment that could save lives.
Gross O, Moerer O, Weber M, Huber TB, Scheithauer S. COVID-19-associated nephritis: early warning for disease severity and complications?. Lancet. 2020;395(10236):e87‐e88. doi:10.1016/S0140-6736(20)31041-2