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LETTER TO THE EDITOR |
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| Ahead of print
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| Long COVID: Information for urology health-care professionals |
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Zohreh Jadali
Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Click here for correspondence address and email
| Date of Submission | 04-Apr-2022 |
| Date of Acceptance | 12-Apr-2022 |
| Date of Web Publication | 26-Oct-2022 |
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Dear Editor,
Long COVID or post-COVID syndrome causes a wide range of medical conditions that linger for at least 12 weeks after the onset of the disease and 30%–80% of COVID-19 survivors develop at least one long-term symptom. However, the actual prevalence of long COVID among COVID-19 survivors seems to be higher than suggested in the literature as data on patients who have mild-to-moderate illness and do not require hospitalization are lacking. In a recent study on the persistent symptoms after acute COVID-19, only 22.9% of the patients were completely asymptomatic for 12 months following the onset of the disease.[1] Some of the symptomatic patients have not been able to return to work and normal living.
Therefore, continuous monitoring of COVID-19 symptoms is necessary to identify the end of the disease and to improve the clinical management. Long-term symptoms might be relapsing-remitting in nature and their duration can vary. For instance, neurocognitive symptoms of long COVID, which are more prevalent in women and the middle-aged, can last for 12 months after the onset of the disease.[1] Additional risk factors for long COVID include more than five symptoms in the acute phase of the disease and comorbidities. The clinical manifestations of long COVID are heterogeneous and can affect a range of organ systems, including the cardiac, respiratory, gastrointestinal, and genitourinary systems. The symptoms such as fatigue, breathlessness, cough, headache, myalgia, weakness, and neurocognitive issues are more common among these patients. Nonetheless, several reports indicated that other organs, including those of the urinary system, are also susceptible to long COVID. For instance, Lamb et al.[2] found that patients with long COVID develop new or worsening symptoms of overactive bladder at 10–12 weeks after hospitalization for COVID-19. A recent study from China also showed that 35% of the patients with COVID-19 had reduced kidney function 6 months after hospitalization.[3]
These findings are in accordance with those obtained in an analysis of the Veterans Health Administration database, which indicated an increased risk of chronic kidney disease, acute kidney injury, and infections of the urinary system in patients with long COVID.[4] Of note, long-term kidney failure is most often found in patients with severe symptoms or life-threatening conditions that require treatment in the intensive care unit. Moreover, patients with COVID-19 who had acute kidney injury are at higher risk for long COVID-related kidney disorders than patients without apparent kidney damage.
Although the exact mechanisms that lead to kidney disorders in long COVID are not known, there are several proposed pathophysiological mechanisms that could explain long-term renal complications. Aberrant immune response, which is thought to be linked to post-COVID conditions, causes chronic inflammation and autoimmune responses due to the production of proinflammatory cytokines, autoantibodies, or autoreactive T-cells. Another reason could be the persistence of SARS-CoV-2 in the body. Prolonged shedding and recurrent detection of genetic material from SARS-CoV-2 in the clinical samples of asymptomatic and symptomatic patients have been well documented. Persistent infection can be pathogenic for the host and have long-term renal consequences. This latent reservoir may contribute to continuous viral evolution in the host, evade the host immune response, and impair this response.[5]
The likelihood of virus persistence appears to increase in people with altered immunity or those with comorbidities. Therefore, these populations are most vulnerable to serious long-term symptoms of renal failure.
Endothelial function impairment, abnormal coagulation, and autonomic nervous system dysfunction seem to be other pathophysiological mechanisms of kidney manifestations in long COVID.[6] Long COVID may have other causes, including nonspecific effect of hospitalization, adverse effects of medications, as well as socioeconomic and psychological issues.[7]
In summary, most recent findings indicate that long COVID can have damaging effects on all body systems, including the renal system. At present, limited data are available on the long-term effects of COVID-19 on kidney function. Urologic manifestations are varied and complex. Therefore, understanding of the causal pathways that contribute to renal deficits can improve the assessment and management of patients with long COVID.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Seeßle J, Waterboer T, Hippchen T, Simon J, Kirchner M, Lim A, et al. Persistent symptoms in adult patients one year after COVID-19: A prospective cohort study. Clin Infect Dis 202;74:1191-8.  |
| 2. | Lamb LE, Timar R, Wills M, Dhar S, Lucas SM, Komnenov D, et al. Long COVID and COVID-19-associated cystitis (CAC). Int Urol Nephrol 2022;54:17-21. |
| 3. | Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: A cohort study. Lancet 2021;397:220-32. |
| 4. | Al-Aly Z, Xie Y, Bowe B. High-dimensional characterization of post-acute sequelae of COVID-19. Nature 2021;594:259-64. |
| 5. | Desimmie BA, Raru YY, Awadh HM, He P, Teka S, Willenburg KS. Insights into SARS-CoV-2 persistence and its relevance. Viruses 2021;13:1025. |
| 6. | Bowe B, Xie Y, Xu E, Al-Aly Z. Kidney outcomes in long COVID. J Am Soc Nephrol 2021;32:2851-62. |
| 7. | Raveendran AV, Jayadevan R, Sashidharan S. Long COVID: An overview. Diabetes Metab Syndr 2021;15:869-75. |
Correspondence Address:
Zohreh Jadali,
Department of Immunology, School of Public Health, Tehran University of Medical Sciences, P. O. BOX: 6446, Tehran 14155
Iran
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/UROS.UROS_39_22
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