Secretion of severe acute respiratory syndrome coronavirus 2 in urine

Abstract

Purpose of review Despite the plethora of publications discussing the severe respiratory coronavirus 2 (SARS-CoV-2), evidence of viral secretion in urine is sparse. Recent findings We could identify 34 publications including a total of 2172 patients. Among those, 549 patients were tested for SARS-CoV-2 secretion in urine, which was detected in only 38 patients (6.9%). Within the seven studies displaying positive results, the majority of positive patients (86.8%) was from not yet peer-reviewed studies including weak data and heterogeneous techniques for sample testing. Furthermore, none of the studies available in the literature addressed the virulence of detected viral RNA in urine. Summary Overall, only seven studies were able to detect SARS-CoV-2 secretion in urine, all of them with a considerably low rate of positivity. However, these studies were of rather low quality considering their methodology. Despite this, as SARS-CoV-2 has been detected in urine, it is of importance to discuss safety and urinary hygiene protocols. Until further research provides valid data on viral shedding and virulence in urine, potential risk of transmission through urine cannot be ruled out. Therefore, safety and hygiene measures need to be discussed.

SARS‐CoV‐2 and its relationship with the genitourinary tract: Implications for male reproductive health in the context of COVID‐19 pandemic

“…Few studies have reported virus isolation from urine samples of patients with severe COVID‐19, most of which including weak data and various techniques for sample urine testing 24,31,32 . A systematic review on COVID‐19 reported a pool of 11 studies with patients who had their urine tested with RT‐PCR for viral RNA.…”

Enumerating asymptomatic COVID-19 cases and estimating SARS-CoV-2 fecal shedding rates via wastewater-based epidemiology

“…Although SARS-CoV-2 has been shown to shed in the upper respiratory tract, the lower respiratory tract, feces, urine and serum (Cevik et al, 2020), WBE leverages RNA shedding of SARS-CoV-2 in feces. Infected persons shed virus into sewage via feces (Cevik et al, 2020), or urine (Brönimann et al, 2020), both of which can then be used to monitor population-level infection changes. Although SARS-CoV-2 has been isolated in urine of a COVID-19 patient (Sun et al, 2020), the incidence of the virus in urine is reported to be low (Brönimann et al, 2020;Morone et al, 2020); whereas, intact SARS-CoV-2 virus have been isolated from feces (Wang et al, 2020;Xiao et al, 2020;Zhang et al, n.d.).…”

Acute kidney injury in COVID-19: are kidneys the target or just collateral damage? A comprehensive assessment of viral RNA and AKI rate in patients with COVID-19

“…Putting all these factors together, these data led to the hypothesis that SARS-CoV-2 targets the kidney. This hypothesis was compounded by data regarding the presence of messenger ribonucleic acid (mRNA) and virus in the kidney tissue [ 14 ▪▪ ], electron microscopy data indicated COVID-19 could be associated with tissue damage [ 15 ▪ ], and evidence of SARS-CoV-2 mRNA was to be found in the patients’ urine [ 4 ▪ , 16 , 17 ]. Moreover, one of the first papers on the topic even suggested that we may observe radiological changes in the kidneys.…”

“…A large number of studies suggest that the presence of ACE-2 receptors in the kidneys would appear to be the main reason for acute kidney injury (AKI) in patients with SARS-CoV-2 [ 2 ]. These data followed by the reports suggesting that the viral ribonucleic acid (RNA) may be isolated from urine [ 3 ] has ignited debates regarding the rate SARS-CoV-2 secretion and virulence in urine [ 4 ▪ ]. The available data on the effect of SARS-CoV-2 on the kidney and urinary system are inconsistent suggesting an AKI rate in 0.1–29% of patients [ 5 , 6 ▪ ].…”