Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Editorial
. 2021 Apr 30;25(1):162.
doi: 10.1186/s13054-021-03579-5.

COVID-19: spot urine rather than bronchoalveolar lavage fluid analysis?

Faeq Husain-Syed  1   2 , Claudio Ronco  3   4 , Thorsten Wiech  5 , Matthias Hecker  1   6 , Werner Seeger  1   6   7
Affiliations
Editorial

COVID-19: spot urine rather than bronchoalveolar lavage fluid analysis?

Faeq Husain-Syed et al. Crit Care. .
No abstract available

PubMed Disclaimer

Conflict of interest statement

FH-S and MH declare no competing interests. CR reports support for acting as an advisory board member for ASAHI, Baxter, GE, Jafron, and Medtronic, and speaker’s fees from Astute, bioMérieux, B. Braun, Cytosorbents, ESTOR, FMC, and Toray, all unrelated to this editorial. TW received speaker’s fees from Novartis and is supported by the Bundesministerium für Bildung und Forschung (BMBF), Netzwerk Universitätsmedizin (DEFEAT PANDEMIcs) unrelated to this editorial. WS report personal fees for consulting from Bayer Pharma, Liquidia Technologies, and United Therapeutics all unrelated to this editorial.

Figures

Fig. 1
Fig. 1
Pulmonary–renal damage patterns of COVID-19. Clinical and histopathological data of COVID-19-associated ARDS and AKI indicate common etiological factors, including direct virus-mediated cell damage, endothelial damage and thrombo-inflammation, dysregulation of the immune response and hyperinflammation, and dysregulation of the renin–angiotensin–aldosterone system. In addition, use of mechanical ventilation, hemodynamic instability, volume overload, superimposed sepsis, and collapsing glomerulopathy have all been implicated in glomerular disease and tubular damage in COVID-19. In contrast to bronchoalveolar lavage fluid, urine is accessible at any time point for non-invasive assessment of organ involvement. The urinary tubuloglomerular pattern may mirror the bronchoalveolar damage pattern and, thus, allow characterization and assessment of the stage of the pulmonary disease by means of serial urine analysis. The table summarizes potential candidate urinary markers that could inform lung injury in the setting of COVID-19-associated ARDS. However, it is unclear which marker is most accurate for this purpose and what cut-offs are needed, and this requires further investigation. The left histopathological image shows diffuse alveolar damage with hyaline membranes at the alveolar walls as morphologic correlate of ARDS. The right histopathological image shows acute tubular injury with flattened brush borders and cytoplasm of the epithelial cells in dilated tubules as morphologic correlate of AKI. ACE2 angiotensin-converting enzyme 2, AKI acute kidney injury, ARDS acute respiratory distress syndrome, COVID-19 coronavirus disease 2019, IGFBP7 insulin-like growth factor-binding protein 7, IL interleukin, PAI-1 plasminogen activator inhibitor-1, NGAL neutrophil gelatinase-associated lipocalin, RAAS renin–angiotensin–aldosterone system, SARS-CoV-2 severe acute respiratory syndrome coronavirus type 2, TIMP-2 tissue inhibitor of metalloproteinases-2, TNFR tumor necrosis factor receptor
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Nadim MK, Forni LG, Mehta RL, Connor MJ, Jr, Liu KD, Ostermann M, Rimmele T, Zarbock A, Bell S, Bihorac A, et al. COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup. Nat Rev Nephrol. 2020;16:765. - PMC - PubMed
    1. Ha H, Oh EY, Lee HB. The role of plasminogen activator inhibitor 1 in renal and cardiovascular diseases. Nat Rev Nephrol. 2009;5:203–211. doi: 10.1038/nrneph.2009.15. - DOI - PubMed
    1. Radtke KP, Fernandez JA, Greengard JS, Tang WW, Wilson CB, Loskutoff DJ, Scharrer I, Griffin JH. Protein C inhibitor is expressed in tubular cells of human kidney. J Clin Investig. 1994;94:2117–2124. doi: 10.1172/JCI117566. - DOI - PMC - PubMed
    1. Liu KD, Glidden DV, Eisner MD, Parsons PE, Ware LB, Wheeler A, Korpak A, Thompson BT, Chertow GM, Matthay MA, et al. Predictive and pathogenetic value of plasma biomarkers for acute kidney injury in patients with acute lung injury. Crit Care Med. 2007;35:2755–2761. - PMC - PubMed
    1. Ostermann M, Zarbock A, Goldstein S, Kashani K, Macedo E, Murugan R, Bell M, Forni L, Guzzi L, Joannidis M, et al. Recommendations on acute kidney injury biomarkers from the acute disease quality initiative consensus conference: a consensus statement. JAMA Netw Open. 2020;3:e2019209. doi: 10.1001/jamanetworkopen.2020.19209. - DOI - PubMed

Publication types

MeSH terms