COVID-19-induced acute renal tubular injury associated with elevation of serum inflammatory cytokine

Clin Exp Nephrol. 2021 Nov;25(11):1240-1246. doi: 10.1007/s10157-021-02101-z. Epub 2021 Jul 10.


Background: Severe acute respiratory syndrome Coronavirus 2 has rapidly spread worldwide, with acute kidney injury (AKI) as one of the manifestations with unknown causal mechanisms. We aimed to investigate tubular injury by assessing tubular markers and their association with the severity of Coronavirus disease 2019 (COVID-19).

Methods: We examined the associations between laboratory markers and urinary levels of N-acetyl-β-D-glucosaminidase (uNAG), β2-microglobulin (u β2MG), α1-microglobulin (u α1MG), and liver-type fatty acid binding protein (L-FABP). We studied 18 COVID-19 patients without previous chronic kidney disease and analyzed the relationship between the urinary biomarkers and inflammatory markers in patients with severe (n = 7) or non-severe (n = 11) COVID-19, defined by requirements of supplemental oxygen.

Results: Fourteen patients (78%) showed abnormal urinalysis findings and two (11%) developed AKI. Patients with severe COVID-19 had significantly higher levels of proteinuria, uNAG, uβ2MG, uα 1MG, and L-FABP than those with non-severe disease. Serum levels of interleukin-6 (IL-6) were significantly higher on admission in all severe COVID-19 cases and correlated with the levels of L-FABP, uβ2MG, uα1MG, uNAG, and proteinuria. Moreover, the changes in serum IL-6 (ΔIL-6) levels from baseline to 7 days after admission significantly correlated with ΔL-FABP and Δuβ2MG.

Conclusions: Levels of tubular injury markers, especially L-FABP and uβ2MG, were significantly associated with IL-6 levels even in patients with no evident AKI. This suggests that L-FABP and uβ2MG could be useful as early detective biomarkers for COVID-19 associated renal injury.

Keywords: Acute tubular injury; COVID-19; Interleukin-6; L-FABP; β2MG.

MeSH terms

  • Acute Kidney Injury / blood*
  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / urine
  • Adult
  • Aged
  • Biomarkers / blood
  • Biomarkers / urine
  • COVID-19 / blood*
  • COVID-19 / complications
  • COVID-19 / diagnosis
  • Cytokines / blood*
  • Fatty Acid-Binding Proteins / urine
  • Female
  • Humans
  • Inflammation Mediators / blood*
  • Interleukin-6 / blood
  • Male
  • Middle Aged
  • Proteinuria / blood
  • Proteinuria / etiology
  • Proteinuria / urine
  • Retrospective Studies
  • Severity of Illness Index
  • Up-Regulation
  • beta 2-Microglobulin / urine


  • B2M protein, human
  • Biomarkers
  • Cytokines
  • FABP1 protein, human
  • Fatty Acid-Binding Proteins
  • IL6 protein, human
  • Inflammation Mediators
  • Interleukin-6
  • beta 2-Microglobulin