At treatment of patients with a new koronavirusny infection (COVID-19) the indicators helping to predict need of the translation such in intensive care unit and an intensive care (ORIT) are necessary. There is an assumption that the analysis of urine made at hospitalization of the patient can be used for identification of a syndrome of system capillary permeability which in turn can be a predictor of a volume overload, respiratory insufficiency, need of hospitalization for ORIT and a lethal outcome.
Whether nephrite and how existence of nephrite can be a harbinger of complications can cause COVID-19? SARS-CoV-2 uses APF2 receptor for penetration into cells, and podocytes express APF2. The posthumous histologic analysis of the material taken from patients with COVID-19 showed existence at them glomerular defeats and a nefritopodobny syndrome. Other zoonotic infections, for example, some hantavirusa, cause a nephrotic syndrome which, in turn, induces a cardiopulmonary syndrome. It is known that complications of a nephrotic syndrome are similar to a syndrome of system capillary permeability and for such states there are methods of preventive therapy.
A number of authors found clinical data which confirm a possibility of development of nephrite in patients with COVID-19. In particular, in the University medical center of Goettingen (Goettingen, Germany) were found changes in the analysis of urine in patients with COVID-19 which condition sharply worsened within several days. On combination of circumstances three from these patients made the test of urine several weeks prior to infection with the coronavirus 2 types causing an acute respiratory distress syndrome (SARS-CoV-2). Results of these analyses of urine were normal. Nevertheless, at one of patients, after SARS-CoV-2 infection, the analysis of urine also showed availability of SARS-CoV-2 RNA. The analysis of samples of urine of other two patients was not made for safety reasons.
A little from these patients with COVID-19 finally came to intensive care unit and an intensive care. Before their receipt in ORIT such features as low concentration of antithrombin (26–62%, referensny value> 70%), an acute hypoalbuminemia were revealed (concentration of albumine in serum of 1.4-1.9 mg/dl, referensny value of 3.4-5.0 mg/dl), and analyses of urine showed availability of albumine, blood and leukocytes.
Unlike patients in ORIT, at patients with weak symptoms is COVID-19 which are in office of therapy of intermediate level, concentration of albumine made more than 2.0 mg/dl, and concentration of antithrombin was low, but within norm. At patients with COVID-19 which were in usual stationary office, the best indicators of level of albumine in serum (more than 2.5 mg/dl) were noted, and results of the analysis of urine were normal.
On the basis of these finds authors removed an algorithm of early identification COVID19 - the associated nephrite and assessment of risk of emergence of a respiratory decompensation at a syndrome of system capillary leak. Patients of average or high severity have to be estimated daily, and the medical staff needs to consider need of use of preventive strategy, for example, at an intersticial fluid lungs, heavy immune insufficiency, cardiovascular insufficiency, trombotichesky events. In case of an aggravation of symptoms of the patient it is necessary to consider the possibility of use of an intensive care and resuscitation strategy. For example, if the condition of the patient worsens (for example, a heavy infection, respiratory insufficiency, need of EKMO), it is possible to consider the possibility of the beginning of replacement renal therapy at an early stage for elimination of a volume overload.
Considering the available data, now a number of authors recommends fixed observation of a condition of patients with the COVID-19-associated nephrite regarding emergence of the following symptoms: an intersticial fluid lungs owing to an acute overload liquid (similarly nephrotic syndrome); immune insufficiency owing to decrease in level of immunoglobulins in kidneys; cardiovascular insufficiency owing to a hypoalbuminemia; undesirable reactions to medicines owing to disturbance of linking of drugs with proteins of plasma and a thromboembolism owing to deficiency of antithrombin.
Summing up the results, it should be noted that the nephrite caused by COVID-19 easily revealed by means of the simple and inexpensive analysis of urine can help to predict development of complications.