Some patients infected with SARS-CoV-2, the coronavirus that causes COVID-19, report severe de novo genitourinary symptoms that investigators have termed COVID-19-associated cystitis (CAC). At the AUA2021 Virtual Experience, the first US group to identify this complication reported that patients with COVID-19, especially those with CAC, have increased levels of inflammatory cytokines in their urine.
Michael Chancellor, MD, of the Beaumont Health System and Oakland University Beaumont School of Medicine in Royal Oak, Michigan, and colleagues asked 53 patients with COVID-19 (discharged from the hospital with normal kidney function) and 12 uninfected patients (control group) to provide a urine sample and complete the AUA/Urology Care Foundation Overactive Bladder (OAB) assessment tool. Patients with COVID-19 reported severe de novo symptoms on the questionnaire, including an increase in urinary urgency, frequency, and nocturia, and noted pain or pressure upon voiding. Nocturia impaired quality of life the most.
Most patients with COVID-19 did not display virus in their urine upon PCR testing, according to the investigators. Compared with the control group, patients with COVID-19 expressed increased levels of several proinflammatory markers, including interleukin 6 (IL-6), interleukin 10 (IL-10), C-reactive protein (CRP), and growth-regulated oncogene-alpha (GRO/CXCL-1). IL-6 is a prime candidate cytokine for mediating inflammation in COVID-19, the investigators explained, and IL-10 is elevated in cytokine storm. GRO/CXCL1 reflects heightened immune responses, they noted, and serum CRP correlates with COVID-19 outcome.
“The variance between individuals [in expression of these markers] may reflect the severity and duration of their disease, and/or the presence of comorbidities,” Dr Chancellor told Renal & Urology News. “The urologic community should be aware that COVID-19 can cause COVID-associated cystitis. Infected patients experiencing urinary symptoms should contact their doctors.”
Chancellor MB, Wills M, Timar R, et al. COVID-19 associated cystitis (CAC): increased urinary symptoms and biomarkers of inflammation in urine in patients with acute COVID-19. Presented at: AUA2021 Virtual Experience held September 10-13, 2021. Poster MP29-15.
Lamb LE, Dhar N, Timar R, Wills M, Dhar S, Chancellor MB. COVID-19 inflammation results in urine cytokine elevation and causes COVID-19 associated cystitis (CAC). Med Hypotheses. 2020 Dec; 145:110375.