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. 2021 Apr 1;16(4):514-521.
doi: 10.2215/CJN.09130620. Epub 2021 Feb 23.

Proteinuria and Clinical Outcomes in Hospitalized COVID-19 Patients: A Retrospective Single-Center Study

Alexandre Karras  1   2 , Marine Livrozet  2   3 , Hélène Lazareth  1   2 , Nicolas Benichou  1   2 , Jean-Sébastien Hulot  2   3 , Antoine Fayol  2   3 , Sophie Chauvet  1   2 , Anne-Sophie Jannot  2   4 , Marie-Aude Penet  2   5 , Jean-Luc Diehl  2   6 , Anne Godier  2   7 , Olivier Sanchez  2   8 , Tristan Mirault  2   9 , Eric Thervet  1   2 , Nicolas Pallet  2   10
Affiliations

Proteinuria and Clinical Outcomes in Hospitalized COVID-19 Patients: A Retrospective Single-Center Study

Alexandre Karras et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Kidney involvement is frequent among patients with coronavirus disease 2019 (COVID-19), and occurrence of AKI is associated with higher mortality in this population. The objective of this study was to describe occurrence and significance of proteinuria in this setting.

Design , setting, participants measurements: We conducted a single-center retrospective study to describe the characteristic features of proteinuria measured within 48 hours following admission among patients with COVID-19 admitted in a tertiary care hospital in France, and to evaluate its association with initiation of dialysis, intensive care unit admission, and death.

Results: Among 200 patients with available data, urine protein-creatinine ratio at admission was ≥1 g/g for 84 (42%), although kidney function was normal in most patients, with a median serum creatinine of 0.94 mg/dl (interquartile range, 0.75-1.21). Median urine albumin-creatinine ratio was 110 mg/g (interquartile range, 50-410), with a urine albumin-protein ratio <50% in 92% of patients. Urine retinol binding protein concentrations, available for 85 patients, were ≥0.03 mg/mmol in 62% of patients. Urine protein-creatinine ratio ≥1 g/g was associated with initiation of dialysis (odds ratio, 4.87; 95% confidence interval, 2.03 to 13.0; P <0.001), admission to the intensive care unit (odds ratio, 3.55; 95% confidence interval, 1.93 to 6.71; P <0.001), and death (odds ratio, 3.56; 95% confidence interval, 1.90 to 6.54; P <0.001).

Conclusions: Proteinuria is very frequent among patients admitted for COVID-19 and may precede AKI. Low levels of albuminuria suggest a predominant tubular origin, confirmed by the elevated levels of urine retinol binding protein. Urine protein-creatinine ratio ≥1 g/g at admission is strongly associated with poor kidney and patient outcome.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Flow diagram. Depicts included and excluded patients, as well as numbers of patients available for each analysis. COVID-19, coronavirus disease 2019; RBP, retinol binding protein; UACR, urine albumin-creatinine ratio; UPCR, urine protein-creatinine ratio.
Figure 2.
Figure 2.
Patient survival with Kaplan–Meier analysis. Analysis of event-free survival according to admission proteinuria ≥1 or <1 g/g.
See this image and copyright information in PMC

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