Department of Urology, University Hospital, Ludwig Maximilian University of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.
Institute of Pathology, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany.
Infection. 2022 Jun;50(3):635-642. doi: 10.1007/s15010-021-01724-4. Epub 2021 Oct 30.
To investigate the expression of the receptor protein ACE-2 alongside the urinary tract, urinary shedding and urinary stability of SARS-CoV-2 RNA.
Immunohistochemical staining was performed on tissue from urological surgery of 10 patients. Further, patients treated for coronavirus disease (COVID-19) at specialized care-units of a university hospital were assessed for detection of SARS-CoV-2 RNA in urinary samples via PCR, disease severity (WHO score), inflammatory response of patients. Finally, the stability of SARS-CoV-2 RNA in urine was analyzed.
High ACE-2 expression (3/3) was observed in the tubules of the kidney and prostate glands, moderate expression in urothelial cells of the bladder (0-2/3) and no expression in kidney glomeruli, muscularis of the bladder and stroma of the prostate (0/3). SARS-CoV-2 RNA was detected in 5/199 urine samples from 64 patients. Viral RNA was detected in the first urinary sample of sequential samples. Viral RNA load from other specimen as nasopharyngeal swabs (NPS) or endotracheal aspirates revealed higher levels than from urine. Detection of SARS-CoV-2 RNA in urine was not associated with impaired WHO score (median 5, range 3-8 vs median 4, range 1-8, p = 0.314), peak white blood cell count (median 24.1 × 1000/ml, range 5.19-48.1 versus median 11.9 × 1000/ml, range 2.9-60.3, p = 0.307), peak CRP (median 20.7 mg/dl, 4.2-40.2 versus median 11.9 mg/dl, range 0.1-51.9, p = 0.316) or peak IL-6 levels (median: 1442 ng/ml, range 26.7-3918 versus median 140 ng/ml, range 3.0-11,041, p = 0.099). SARS-CoV-2 RNA was stable under different storage conditions and after freeze-thaw cycles.
SARS-CoV-2 RNA in the urine of COVID-19 patients occurs infrequently. The viral RNA load and dynamics of SARS-CoV-2 RNA shedding suggest no relevant route of transmission through the urinary tract.
研究 SARS-CoV-2 受体蛋白 ACE-2 在尿路中的表达以及其尿路上皮脱落和尿液稳定性。
对 10 名接受泌尿外科手术患者的组织进行免疫组织化学染色。此外，对在大学医院专门护理病房接受冠状病毒病（COVID-19）治疗的患者进行评估，通过 PCR 检测尿液样本中 SARS-CoV-2 RNA 的存在，疾病严重程度（WHO 评分）和患者的炎症反应。最后，分析 SARS-CoV-2 RNA 在尿液中的稳定性。
在肾脏和前列腺的肾小管中观察到高 ACE-2 表达（3/3），在膀胱的尿路上皮细胞中观察到中度表达（0-2/3），而在肾小球、膀胱平滑肌和前列腺基质中则无表达（0/3）。在 64 名患者的 199 份尿液样本中检测到 5 份 SARS-CoV-2 RNA。在连续样本的第一个尿液样本中检测到病毒 RNA。与鼻咽拭子（NPS）或气管抽吸物相比，来自其他标本的病毒 RNA 载量更高。尿液中检测到 SARS-CoV-2 RNA 与受损的 WHO 评分（中位数 5，范围 3-8 与中位数 4，范围 1-8，p=0.314）、白细胞计数峰值（中位数 24.1×1000/ml，范围 5.19-48.1 与中位数 11.9×1000/ml，范围 2.9-60.3，p=0.307）、CRP 峰值（中位数 20.7mg/dl，范围 4.2-40.2 与中位数 11.9mg/dl，范围 0.1-51.9，p=0.316）或 IL-6 峰值水平（中位数：1442ng/ml，范围 26.7-3918 与中位数 140ng/ml，范围 3.0-11，041，p=0.099）无关。SARS-CoV-2 RNA 在不同储存条件下和冻融循环后均稳定。
COVID-19 患者尿液中 SARS-CoV-2 RNA 很少发生。病毒 RNA 载量和 SARS-CoV-2 RNA 脱落的动态变化表明，通过尿路传播的可能性不大。
