SARS-CoV-2 infection does not significantly cause acute renal injury: an analysis of 116 hospitalized patients with COVID-19 in a single hospital, Wuhan, China

Abstract

ContributorsZG and YL made substantial contributions to the study concept and design. LW was in charge of the manuscript draft. XL, CH, SY and DL took responsibility for obtaining written consent from patients, obtaining ethical approval, collecting samples, and confirming data accuracy. LW and ZG participated in drafting the manuscript, and revising it on the basis of reviewers' comments. LW made substantial contributions to data acquisition, analysis, and interpretation. Declaration of interestsWe declare no competing interests. Data sharingWith the permission of the corresponding authors, we can provide participant data without names and identifiers, but not the study protocol, statistical analysis plan, or informed consent form. Data can be provided after the Article is published. Once the data can be made public, the research team will provide an email address for communication. The corresponding authors have the right to decide whether to share the data or not based on the research objectives and plan provided.All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

SARS-CoV-2–Positive Sputum and Feces After Conversion of Pharyngeal Samples in Patients With COVID-19

“…Real-time quantitative fluorescence polymerase chain reaction (RT-qPCR) testing of respiratory specimens for SARS-CoV-2 RNA is currently used for case diagnosis and to guide the duration of patient isolation or hospital discharge (1). Specimens that are positive on RT-qPCR have, however, also been reported from blood (2), feces (3), and urine (4). Whether testing of multiple body sites is important when considering patient isolation has not been thoroughly studied.…”

Systemic analysis of tissue cells potentially vulnerable to SARS-CoV-2 infection by the protein-proofed single-cell RNA profiling of ACE2, TMPRSS2 and Furin proteases

“…However, the COVID-19 patients primarily displayed symptoms from respiratory systems, where ACE2 is expressed in a small portion of cells. Even for severely ill patients, the injuries or symptoms in the ACE2-high organs such as kidney and intestinal tract are relatively uncommon, with a rate of 1%-4.3% for acute kidney injury [1,25], and a rate of 3.5%-5.8% for intestinal symptoms [1,47]. Instead, the injuries in ACE2-median organs such as heart are more frequent (12%-19%) [1,47].…”

“…Based on the profiling of ACE2 mRNA expression in different tissues/organs, multiple types of cells were proposed to be potentially targeted by SARS-CoV-2 virus, including the lung alveolar type 2 (AT2) cells [18], nasal epithelial cells [19], esophageal epithelial cells and intestinal enterocytes [20], liver cholangiocytes [21], cardiomyocytes [22], kidney proximal tubule cells [23], spermatogonia and Leydig/sertoli cells in testis [24]. However, unparallel to the many potential targets cells and organs proposed, the COVID-19 patients primarily displayed typical symptoms of inflammation in lung, where only a very small portion of cells (~0.64% of total cells, and ~1.4% of AT2 cells) expressed ACE2 mRNA [18]; meanwhile, the injuries in other organs/tissues, such as kidney and the intestinal track where ACE2 RNA expressed at high levels, seemed to be uncommon [1,25]. This obvious discrepancy suggests that mechanisms other than ACE2 mRNA levels are also involved in the regulation of SARS-CoV-2 infection of their target cells.…”

Potential Pathogenesis of Multiple Organ Injury in COVID-19

“…It can be observed that th e number of deaths caused by ARDS is also much higher than that caused by AKI. ( 267 33(12.4%) NA medRxiv [6] 116 16(13.8%) 0 medRxiv [17] 710 NA 22(3.2%) medRxiv [18] 109 53(48.6%) NA medRxiv [19] [21] 36 36(100%) 1(2.78%) medRxiv [22] Fig.4 ACE2 protein-protein interaction (PPI) functional Network…”

“…According to the distribution of ACE2 in tissues and organs, some studies have proposed that testis and kidneys are potentially damaged organs of COVID-19 [27] .In the clinical study of renal injury in patients with COVID-19, the risk of death in patients with COID-19 renal injury is higher, but the complication rate of COVID-19 in this study is only 3.2% [18] , which is also much lower than the previously reported proportion of ARDS. However, in Wang Luwen's study [17] , a total of 116 patients with COVID-19 were enrolled in the study, and it was found that there were no clinical manifestations of acute renal injury. We can note that the incidence of AKI caused by COVID-19 is relatively low, which further indicates that there are other potential targets involved in COVID-19-induced lung injury.…”