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COVID-19: early warning sign of serious illnesses
The number of people who are infected with the new SARS-CoV-2 coronavirus is no longer increasing as much as it was a few weeks ago. Not all people who contract the pathogen fall ill. But there are also serious illnesses that often end in death. A new urine test should now help to find out at an early stage who is at high risk.
"The course of the disease is non-specific, varied and varies widely, from symptom-free courses to severe pneumonia with lung failure and death," writes the Robert Koch Institute (RKI) on the courses of Coronavirus Disease 2019 (COVID-19). Old age and obesity are considered important risk factors for serious illnesses. However, the infection can also have dramatic effects in younger or not overweight people. A urine test could help to find out early on who it is.
Prevent life-threatening deterioration and death
According to a recent announcement by the University Medical Center Göttingen (UMG), UMG experts have developed a path for the early detection and treatment of severe courses of COVID-19 infections.
According to this, a simple urine test should help medical professionals to recognize warning signs of an impending severe course of COVID-19 disease earlier.
Treating impending complications can be started with just a few parameters, days before the lungs and other organs fail. This could prevent life-threatening deteriorations and deaths in many patients.
The scientists' findings were published online as "Correspondence" in the renowned journal "The Lancet".
Improve health care for COVID-19 infections
A large, non-interventional observational study entitled “Covid-19 associated nephritis as a predictor of disease severity and complications” is currently being conducted to determine whether and to what extent the proposed course of action can improve patient care for COVID-19 infections of several university hospitals in Germany.
In the inpatient treatment of COVID-19 infections, the UMG team noticed that especially in the seriously ill - in addition to the lungs and heart - the kidneys were affected at an early stage.
As a result, the UMG doctors began to evaluate and discuss their findings with specialists from the University Clinic Hamburg-Eppendorf and other German university clinics and to exchange ideas with experts from Italy, China, England and the USA.
Current tissue examinations of the deceased support the assumption that due to the drama of the disease of the other organs, early kidney involvement has so far been neglected.
Life-threatening loss of blood components
If urine is suspected of COVID-19-associated inflammation of the kidneys (nephritis), the UMG's path of action is followed by the determination of only three other simple parameters: albumin in the blood, albumin in the urine and antithrombin III.
Together with the urine findings, these three parameters are used to diagnose the so-called "capillary leak syndrome". As explained in the release, this means a life-threatening loss of blood components and protein from the blood into the (lung) tissue through a general leakage of the small blood vessels caused by the virus. The risk classification of the patients is based on the three parameters.
"If even one of three parameters is changed, there is a high risk that the patients in the normal ward will deteriorate promptly, have to be transferred to the intensive care unit, or that the course in the intensive care unit will deteriorate," explains the first author of the publication, Prof Dr. Oliver Gross, senior physician at the UMG Clinic for Nephrology and Rheumatology.
What the specialist staff must pay particular attention to
As stated in the communication, the UMG's path of action for the early detection of capillary-leak syndrome in COVID-19 sufferers sensitizes them to orienting their actions early on to critical blood values in connection with a COVID disease:
If there is a severe lack of albumin in the blood, an interstitial pulmonary edema (water lung) develops. The capillary leak leads to the loss of albumin from the blood into the lung tissue, the lung tissue swells, breathing and the exchange of oxygen are made more difficult.
According to the experts, the water retention is treated with drainage tablets. Due to the early detection of the severe lack of albumin in the blood, the specialist staff knows early on what to watch out for:
- Drainage therapy can begin before breathing worsens.
- The drainage medication works less well with albumin deficiency. Significantly higher doses are therefore needed for drainage. Or dialysis machines have to be used earlier for water withdrawal before the lung tissue is full of water.
- Critical drugs, such as antibiotics, may have an unexpectedly different concentration of active substances due to the changed plasma protein binding. Therefore, the drug levels should be determined preventively.
- The lack of protein in the blood can particularly easily lead to circulatory failure. Preventive measures can be taken at an early stage.
If there is a severe lack of antithrombin III in the blood, this will result in thrombosis (clots in the blood vessels) and thromboembolism (clots loosen and clog the pulmonary vessels).
Blood thinners, such as heparin, are used preventively to prevent thrombosis and thromboembolism. Due to the early detection of severe antithrombin deficiency in the blood, the specialist staff knows here in advance what to look out for:
- Preventive therapy with blood thinners can start before blood clots form.
- The most common blood thinning agent, heparin, does not work properly because heparin works via antithrombin. Therefore, significantly higher doses of heparin are usually required to achieve the desired preventive effect and thus prevent blood clots.
“If the findings of the UMG medical team are confirmed, this would have a lasting effect. In this way, the need for an upcoming intensive care unit treatment could be predicted in advance, ”said the publication's senior author, Prof. Simone Scheithauer, director of the UMG's Institute for Hospital Hygiene and Infectiology.
“In addition, patients could be assigned earlier and more appropriately for special therapies (also in drug studies). Early detection of the capillary-leak syndrome could initiate symptomatic preventive therapies and possibly even prevent life-threatening courses, ”says Prof. Scheithauer.
Also suitable for those affected in nursing homes
Since the UMG's path of action begins with a simple urine examination, the authors consider the procedure to be suitable for COVID-19 patient groups in nursing homes and for those affected who are initially treated at home after diagnosis.
Here, the urine test could serve as an early warning sign that the physical condition is in danger of deteriorating. For example, an outpatient measure could start earlier and prevent further damage and maybe even a hospital stay. (ad)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- Universitätsmedizin Göttingen (UMG): Inflamed kidneys as an early warning sign of severe progress in COVID-19, (accessed: May 9, 2020), Universitätsmedizin Göttingen (UMG)
- Oliver Gross, Onnen Moerer, Manfred Weber, Tobias B Huber, Simone Scheithauer: COVID-19-associated nephritis: early warning for disease severity and complications ?; in: The Lancet, (published: 06.05.2020), The Lancet
- Robert Koch Institute (RKI): SARS-CoV-2 Fact Sheet for Coronavirus Disease-2019 (COVID-19), (accessed: May 9, 2020), Robert Koch Institute (RKI)