Department of Nephrology, Dialysis and Transplantation, Faculty of Medicine, Gazi University, Bahriye Ucok, 06560, Ankara, Turkey.
Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey.
Int Urol Nephrol. 2022 Mar;54(3):627-636. doi: 10.1007/s11255-021-02937-0. Epub 2021 Jul 2.
To evaluate urinary kidney injury molecule-1 (uKIM-1), which is a proximal tubule injury biomarker in subclinical acute kidney injury (AKI) that may occur in COVID-19 infection.
The study included proteinuric (n = 30) and non-proteinuric (n = 30) patients diagnosed with mild/moderate COVID-19 infection between March and September 2020 and healthy individuals as a control group (n = 20). The uKIM-1, serum creatinine, cystatin C, spot urine protein, creatinine, and albumin levels of the patients were evaluated again after an average of 21 days.
The median (interquartile range) uKIM-1 level at the time of presentation was 246 (141-347) pg/mL in the proteinuric group, 83 (29-217) pg/mL in the non-proteinuric group, and 55 (21-123) pg/mL in the control group and significantly high in the proteinuric group than the others (p < 0.001). Creatinine and cystatin C were significantly higher in the proteinuric group than in the group without proteinuria, but none of the patients met the KDIGO-AKI criteria. uKIM-1 had a positive correlation with PCR, non-albumin proteinuria, creatinine, cystatin C, CRP, fibrinogen, LDH, and ferritin, and a negative correlation with eGFR and albumin (p < 0.05). In the multivariate regression analysis, non-albumin proteinuria (p = 0.048) and BUN (p = 0.034) were identified as independent factors predicting a high uKIM-1 level. After 21 ± 4 days, proteinuria regressed to normal levels in 20 (67%) patients in the proteinuric group. In addition, the uKIM-1 level, albuminuria, non-albumin proteinuria, and CRP significantly decreased.
Our findings support that the kidney is one of the target organs of the COVID-19 and it may cause proximal tubule injury even in patients that do not present with AKI or critical/severe COVID-19 infection.
评估尿肾损伤分子-1（uKIM-1），这是一种在 COVID-19 感染中可能发生的亚临床急性肾损伤（AKI）的近端肾小管损伤生物标志物。
该研究纳入了 2020 年 3 月至 9 月期间被诊断为轻度/中度 COVID-19 感染的蛋白尿（n=30）和非蛋白尿（n=30）患者以及健康个体作为对照组（n=20）。患者的 uKIM-1、血清肌酐、胱抑素 C、尿蛋白、肌酐和白蛋白水平在平均 21 天后再次评估。
蛋白尿组患者就诊时的 uKIM-1 中位数（四分位距）为 246（141-347）pg/mL，非蛋白尿组为 83（29-217）pg/mL，对照组为 55（21-123）pg/mL，蛋白尿组显著高于其他两组（p<0.001）。蛋白尿组的肌酐和胱抑素 C 明显高于无蛋白尿组，但均不符合 KDIGO-AKI 标准。uKIM-1 与 PCR、非白蛋白尿蛋白、肌酐、胱抑素 C、CRP、纤维蛋白原、LDH 和铁蛋白呈正相关，与 eGFR 和白蛋白呈负相关（p<0.05）。在多变量回归分析中，非白蛋白尿蛋白（p=0.048）和 BUN（p=0.034）被确定为预测 uKIM-1 高水平的独立因素。21±4 天后，蛋白尿组 20（67%）名患者的蛋白尿恢复正常。此外，uKIM-1 水平、白蛋白尿、非白蛋白尿蛋白和 CRP 显著降低。
我们的研究结果支持肾脏是 COVID-19 的靶器官之一，即使在没有 AKI 或严重/危重 COVID-19 感染的患者中，它也可能导致近端肾小管损伤。
