Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan.
Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan; Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Int J Infect Dis. 2022 Apr;117:302-311. doi: 10.1016/j.ijid.2022.02.024. Epub 2022 Feb 17.
Acute renal injury is an important complication of coronavirus disease 2019 (COVID-19). Both COVID-19-specific mechanisms, such as damage to the renal parenchyma by direct infection, and non-specific mechanisms, such as the pre-renal injury factors, have been proposed to be involved in COVID-19-associated renal injuries. In this study, we aimed to elucidate the characteristics of COVID-19-associated renal injuries, focusing mainly on urine sediment findings.
We compared the urine sediment findings and their associations with renal functions or urinary clinical parameters between subjects with COVID-19 and subjects without COVID-19 with acute renal injuries.
We found that the number of urine sediment particles and the levels of N-acetyl-β-D-glucosaminidase, α1-microglobulin, liver type fatty acid-binding protein, and neutrophil gelatinase-associated lipocalin were associated with the severity of COVID-19. In addition, we observed that the number of granular casts, epithelial casts, waxy casts, and urinary chemical marker levels were lower in the subjects with COVID-19 than subjects without COVID-19 with acute renal injuries when the subjects were classified according to their renal function.
These results suggest that pre-renal injury factors might be largely involved in the pathogenesis of COVID-19-associated renal injuries compared with non-COVID-19-associated renal injuries arising from surgery or sepsis.
急性肾损伤是 2019 年冠状病毒病（COVID-19）的重要并发症。COVID-19 特异性机制，如直接感染对肾实质的损害，以及非特异性机制，如肾前损伤因素，都被认为与 COVID-19 相关的肾损伤有关。在本研究中，我们旨在阐明 COVID-19 相关肾损伤的特征，主要关注尿沉渣发现。
我们比较了 COVID-19 患者和非 COVID-19 急性肾损伤患者的尿沉渣发现及其与肾功能或尿临床参数的关系。
我们发现尿沉渣颗粒数以及 N-乙酰-β-D-氨基葡萄糖苷酶、α1-微球蛋白、肝型脂肪酸结合蛋白和中性粒细胞明胶酶相关脂质运载蛋白的水平与 COVID-19 的严重程度相关。此外，我们观察到，根据肾功能对患者进行分类时，COVID-19 患者的颗粒管型、上皮管型、蜡样管型数量以及尿化学标志物水平均低于非 COVID-19 相关急性肾损伤患者。
这些结果表明，与手术或脓毒症引起的非 COVID-19 相关肾损伤相比，肾前损伤因素可能在 COVID-19 相关肾损伤的发病机制中起更大作用。
