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Introduction: Hospitalized COVID-19 patients are at increased risk for acute kidney injury (AKI, incidence 0.5-80%), which contributes to increased morbidity and mortality. However, the long-term effect of COVID-19 on kidney function is unclear, particularly in populations with a high prevalence of chronic kidney disease like ours. The aim was to assess the evolution, at least 6 months after hospital discharge, of kidney function in COVID-19 survivors who were hospitalized and did or did not develop AKI (KDIGO criteria). Additionally, patient survival was analyzed. Method(s): Prospective cohort of surviving patients with confirmed COVID-19 diagnosis, treated in our hospital from 08/Mar/2020 to 16/Oct/2021. From the inpatient registry, survivors were contacted by telephone;those who agreed to participate had a clinical interview and measurement of biochemical variables, including estimated glomerular filtration rate (eGFR) and albumin/creatinine ratio (ACR) in a single urine sample. Result(s): Of 585 patients hospitalized for COVID-19 and discharged alive, 121 (21%) developed AKI. So far, 166 without AKI and 34 with AKI have been included. Patient evaluations were performed at a mean (+/-SE) of 20.0+/-0.3 months, and main comparisons between groups are shown in Table 1 and Table 2.Overall mean time survival (+/-SE) was 26.1+/-0.5 months, and comparison of survival according to the development of AKI is shown in Figure. [Formula presented] [Formula presented] [Formula presented] Conclusion(s): A fifth part of surviving patients hospitalized for COVID-19 developed AKI, 73% of them recovered kidney function upon discharge. Patients who developed AKI had lower kidney function throughout the study and a higher ACR at the end of follow-up compared to those without AKI;however, this latter group displayed a slight decrease in eGFR at the end of the study compared to its baseline value. Survival of patients was significantly lower in those with AKI, and it was worse in those with higher stages. No conflict of interestCopyright © 2023
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Background and Aims: In the Covid era, Continuous blood glucose monitoring(CGM) was used more frequently and it proved to be quite a helpful and accurate tool for glycemic regulation. Method(s): 75 yrs old Saudi gentleman, had Type 2 diabetes >30yrs, Hypertension, Primary Hypothyroidism, dyslipidemia, mixed polyneuropathy, Iron deficiency anemia, and benign prostatic hypertrophy. In March,2020 his BP and blood glucose readings were high at home. He had a past history of subdural hematoma with hydrocephalus(staus post-shunting). He was on Glargine, oral hypoglycemic agents, anti-hypertensives, Levothyroxine, Atorvastatin, Aspirin, iron fumarate, calcium carbonate and cholecalciferol. Fully conscious, and co-operative, of average built and height.BP 170/70 mmHg, pulse 93/m, RR 18/ m,O2sat 100%, afebrile, BMI 24.96 kg/m2. Fundoscopy normal. He had dry feet and impaired monofilament and vibration testing. Result(s): Hb% 13.1g/dl(12.6 before),MCV 93.8fl,S.Ferritin 10.5ug/l(30-400),Vit.B12 270 pmol/l(145-637),HbA1c 8%(6.4 in Feb.2020).The renal, liver and thyroid functions-intact. Albumin creatinine ratio 12.23mg/g(0-30). Nerve conduction study-mixed polyneuropathy. He continued to follow-up physically even during the Covid crisis due to the elevated SMBG and BP values. Gliclazide & antihypertensive doses were optimized and Glargine was started.On patient's follow-up in August, 2020, time in range had improved to 80%(33% in June,2020),average glucose was 147 mg/dl(200 before), glucose variability was 27.8%(28.9), hypoglycemia (54-79mg/dl) was 1%(0). On last follow-up on 27.06.2022 his HbA1c had climbed up to 8.3%(7.3 in September, 2021). He was compliant to the diabetes regime, but had stopped using the Libre sensor. Conclusion(s): The case signifies the advantage of a meticulous CGM usage during the Covid pandemic, that resulted in a reasonable glycemic control.
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The COVID-19 pandemic has reinforced Australia's need for diagnostic testing frameworks that are well-prepared, well-resourced, responsive, appropriately governed, scalable, interdisciplinary and collaborative.1 Point-of-care (POC) technologies offer diagnostic solutions capable of delivering individual, community and public health benefits in settings where: a) laboratory testing is not available, b) rapid turn-around time is needed, c) high loss to follow-up occurs in high-risk populations with standard of care cascades and/or d) disease transmission rates exceed laboratory response capacity. Key translational research derived from collaborative point-of-care testing networks for a) diabetes management (238 remote health services;3,233 operators;172,069 HbA1c and 51,379 urine albumin:creatinine ratio tests), b) acute care (106 remote health services;2,279 operators;32,950 blood gas, 32,689 cardiac troponin, 46,418 urea/electrolytes, 48,193 international normalised ratio tests), c) hepatitis C virus (HCV) (41 sites;110 operators;5,733 HCV tests;4,978 RNA, 755 antibody), d) syphilis screening (156 sites;1,412 operators), e) chlamydia, gonorrhea or trichomonas (51 sites;795 operators;>50,000 tests) or f) COVID-19 (101 remote health services, 733 operators, 72,624 tests) will be used to highlight operational, clinical, public health, and economic benefits of POC testing. Challenges associated with scale-up and accreditation pathways for decentralised POC testing will be discussed. Reference 1. Revised Testing Framework for COVID-19 in Australia, March 2022 Version 2.1. Communicable Disease Network Australia and Public Health Laboratory Network. Copyright © 2022
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Background and Aims : Cardiovascular disease (CVD) affects approximately one third of type 2 diabetes mellitus (T2DM) patients. We aimed to evaluate treatment targets of T2DM patients with CVD. Method(s): This retrospective study included 469 T2DM patients attending a Diabetes Center before COVID-19 (08.2016-12.2019). Data regarding diabetes history, complications and comorbidities, anthropometric parameters, metabolic profile were collected from medical records. Result(s): The patients' mean age was 62.27+/-9.98 and 48.8% were men. The mean diabetes duration was 6.81+/-7.04 years and the metabolic parameters were: BMI 31.78+/-5.32 kg/m2, HbA1c 7.5+/-1.47%, glycaemia 159.96+/-49.31 mg/dl, LDL-cholesterol 99.60+/-42.68 mg/dl, triglycerides 200.33+/-143.37 mg/dl. 203 patients had atherosclerotic CVD (angina, cardiac ischemic disease, peripheral arterial disease). A comparative analysis revealed higher values in CVD patients for age, diabetes duration, abdominal circumference, glycaemia, urinary albumin to creatinine ratio (ACR), p <0.05. Diabetes duration and ACR seemed to be predictive factors for CVD (AUC=0.579, p <0.01, CI=0.52 - 0.63, respectively AUC=0.607, p <0.01, CI=0.52 - 0.68). Regarding treatment targets of CVD patients, 45.5% had systolic blood pressure <130 mmHg, 14.8% had LDL-cholesterol <55 mg/dl, and 26.6% had HbA1c <7%. Conclusion(s): In clinical practice, some T2DM patients fail to achieve cardio-metabolic control even if managed according to the latest ESC recommendations. Copyright © 2022
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Background: Angiotensin-converting enzyme 2(ACE2), the receptor for SARSCoV-2, is highly expressed in the kidneys. ACE2 also possess a unique function to facilitate amino acid absorption. A persistent elevation in plasma ACE2 during COVID-19 is related to increased mortality. The present study sought to explore the relationship between urine ACE2(uACE2) and renal outcomes in COVID-19 patients. Method(s): In 104 COVID-19 patients without acute kidney injury(AKI), 43 patients with COVID-19-mediated AKI, and 36 non-COVID-19 controls, uACE2, urine tumor necrosis factor receptors I and II(uTNF-RI and uTNF-RII), neutrophil gelatinaseassociated lipocalin(uNGAL), and urine albumin-creatinine ratio were measured. We also assessed ACE2 staining in autopsy kidney samples and generated a propensityscore matched subgroup to perform a targeted urine metabolomic study to describe the characteristic urine signature of COVID-19. Result(s): uACE2 was increased in patients with COVID-19, and further increased in those that developed AKI(Figure 1). After adjusting uACE2 levels for age, sex and previous comorbidities, increased uACE2 was independently associated with over 3-fold higher risk(OR 3.05,95%CI:1.23-7.58, p=0.017) of developing AKI. Increased uACE2 corresponded to a tubular loss of ACE2 in kidney sections and strongly correlated with uTNF-RI and uTNF-RII, suggesting that ADAM17 could be responsible for ACE2 shedding. Urine quantitative metabolome analysis revealed an increased excretion of essential amino acids in COVID-19 patients, including leucine, isoleucine, tryptophan and phenylalanine. Additionally, a strong correlation was observed between urine amino acids and uACE2(Figure 1). Conclusion(s): Elevated uACE2 is related to AKI in patients with COVID-19. The loss of tubular ACE2 during SARS-CoV-2 infection demonstrates a potential link between aminoaciduria and proximal tubular injury.
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Introduction: Emergency use authorization and mass vaccination programs worldwide have lowered the burden of the COVID-19 pandemic. Vaccine complications not previously seen in clinical studies continue to manifest. We present a case of membranous nephropathy (MN) following the SARS-CoV-2 vaccination with successful treatment. Case Description: Our patient is a 58-year-old woman with past medical history of hypothyroidism seen at a nephrology clinic for evaluation of new onset symptoms of dyspnea, severe bilateral pedal edema, and proximal muscle weakness for 4 months. The patient had 3+ proteinuria and microscopic hematuria on urinalysis obtained by primary care provider. She also had a rapid decline in serum albumin to 2.2 g/dL and new onset hypercholesteremia at 415 mg/dL. Before initial presentation, she had normal labs and no symptoms. Upon presentation to our nephrology clinic, the patient had proteinuria of 2,360 mg/day on a 24-hour urine collection, random urine protein-to-creatinine ratio (UPCR) of 5,459 mg/g and random urine albumin-to-creatinine ratio (UACR) of 3,539 mg/g. She had no risk factors for chronic kidney disease. The only recent change in the health management of the patient was the administration of two doses of the SARS-CoV-2 vaccine several weeks prior to presenting with her initial symptoms 4 months ago. The phospholipase A2 receptor (PLA2R) antibody was elevated at 287 IU/mL. Serological tests for other sources of proteinuria were negative. Renal biopsy performed was consistent with primary MN. The patient was started on rituximab infusion given 2 weeks apart based on Mentor Trial. Additional treatment included apixaban, sulfamethoxazole/ trimethoprim DS, losartan, and L-carnitine. After two doses of rituximab, she had resolution of dyspnea, pedal edema and muscle weakness. Repeat labs revealed UPCR to 1000 mg/g, UACR to 629 mg/g, improvement of PLA2R to 8 IU/mL. Our patient achieved immunological remission and partial clinical remission. Discussion(s): This case illustrates a potential association of the SARS-CoV-2 vaccination and autoimmune mimicry leading to MN. We hope that this will help clinicians become aware of a potential complication not widely recognized and an effective management strategy. We hope further investigations of this possible association are performed as more cases are discovered.
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Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, on KTR remains unknown. We aimed to determine the impact of COVID-19 illness on kidney graft function including graft loss and characterize Long COVID (LC) symptoms in KTR. Method(s): Clinical data were extracted from an established registry of KTR diagnosed with COVID-19 between February 2020 to April 2022. A LC symptom questionnaire was developed and distributed. KTR that self-reported COVID-19 associated symptoms >=2 months were considered to have Long COVID (LC). Result(s): Of the 121 post COVID-19 KTR, 15 (12%) developed graft dysfunction defined as an increase in serum creatinine >0.3 mg/dL. Characteristics of KTR stratified as with and without graft dysfunction are shown in Table 1. Urine albumin/creatinine ratio was higher in the group with dysfunction and 2 (1.6%) KTR lost their allografts as well. Four (18%) reported LC symptoms and the frequency of LC symptoms among the first 22 questionnaire respondents are shown in Figure 1. Conclusion(s): Both allograft injury and LC symptoms are frequent among KTR. Identification of risk factors for long-term complications post COVID-19 and development of mechanism-based interventions may mitigate post COVID-19 sequalae in KTR.
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Introduction: Kidney involvement is common in multiple myeloma (MM) and is associated with increased mortality. Light chain cast nephropathy, monoclonal immunoglobulin deposition disease and light chain amyloidosis are the most frequent presentations. Very few cases are reported of MM presenting as crescentic glomerulonephritis (CGN). Here, we present a case of a female with rapidly progressive loss of renal function and proteinuria who was found to have MM and CGN. Case Description: A 45-year old woman with h/o hypertension, diabetes mellitus, GERD, iron deficiency anemia, nephrolithiasis and COVID infection six months presented with worsening renal function. Her baseline creatinine three months prior was 0.88 mg/dL eGFR >60 and had recently increased to 2.81 mg/dL eGFR of 22. Laboratory investigations revealed a hemoglobin 8.3 g/dL, platelet count 404 x 10x9/L. Serum calcium and uric acid levels were within normal limits. Urinalysis showed proteinuria without hematuria with a urine protein/creatinine ratio 1.9 g/g, urine albumin/creatinine ratio 506 mg/g and urine albumin/protein ratio of 0.27. Complement levels, ANCA, Anti-GBM, ANA, RF and hepatitis serology were all unrevealing. Serum Kappa and Lambda free light chains were elevated with ratio being of 0.09. Bone marrow was done which demonstrated approximately 10% lambda restricted plasma cell clones. In view of progressive renal dysfunction she was admitted with the suspicious of light chain nephropathy for consideration of plasma exchange therapy. Kidney biopsy was obtained which showed findings consistent with crescentic GN, with weak linear IgG staining along glomerular basement membranes without evidence of cast nephropathy, monoclonal immunoglobulin deposition or amyloidosis. The patient was started on Cyclophosphamide-Bortezomib-Dexamethasone regimen and since then her kidney function has remained stable. Discussion(s): Rare kidney findings in patients with MM include membranoproliferative GN, cryoglobulinemia, immunotactoid and fibrillary glomerulopathy. MM associated Crescentic GN is extremely rare. Its etiology and pathophysiology is unclear but it seems that treatment of MM may temporarily halt its progression as in this case.
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Background & Aim: Funded in 2015, the NEPHSTROM EU-H2020 consortium aimed to translate pre-clinical evidence of efficacy of “off-the-shelf” intravenous (i.v.) allogeneic mesenchymal stromal cells (allo-MSC) in diabetic nephropathy to early-phase clinical investigation in patients with progressive diabetic kidney disease (DKD). Methods, Results & Conclusion: Methods: The trial IMP, NEPHSTROM ORBCEL-M, consists of cryopreserved, CD362-selected bone marrow allo-MSCs or matching placebo (cryopreservation fluid). The protocol for a multi-site, randomised, placebo-controlled, double- blind, dose-escalation phase-1b clinical trial in adults with DKD due to type 2 diabetes was designed collaboratively by a group of academic nephrologists and cell therapy specialists from Italy, the UK, Ireland and the Netherlands. Inclusion criteria included age 40-85 yrs and type 2 diabetes with evidence of progressive DKD [eGFR 25- 55mL/min/1.73m2, urine albumin creatinine ratio >88mg/g and rapid eGFR decline or ≥15% risk of ESRD within 5 years]. Three dose cohorts were planned, each with n=12 NEPHSTROM ORBCEL-M recipients + n=4 Placebo recipients and 18 months follow-up. Results: Following regulatory approval of the trial dossier through the EMA’s Voluntary Harmonisation Procedure and ethical approvals at the Sponsor site (Bergamo, Italy) and three other sites (Galway, Ireland;Birmingham and Belfast, UK), the NEPHSTROM trial (NCT02585622) opened March 2018. To date, 27 patients have been treated and 14 have completed the trial protocol. We report here our (as-yet blinded) experiences with the first fixed-dose cohort (80x10e6 cells/placebo i.v.), consisting of 16 subjects enrolled at 3 sites and followed for 18 months. The trial intervention proved safe, with one quickly-resolved infusion reaction and no subsequent SAEs ascribed to the IMP. Two patients died of unrelated causes between 12 and 18 months. Serial serum assays for anti-HLA antibodies indicated no persistent allo-immune sensitisation. NEPHSTROM ORBCEL-M effects on trends in eGFR, true GFR (iohexol clearance), albuminuria, serum/plasma inflammatory biomarkers and immune cell profiles will be analysed after unblinding. Following DSMB approval and COVID-19-related trial pauses, 11 second dose cohort subjects (160x10e6 cells/placebo i.v.) have been treated and are undergoing follow-up with no IMP-related adverse events to date. Conclusion: A novel, off-the-shelf, i.v. allo-MSC IMP has thus far proven safe and feasible in adults with progressive DKD.
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Objectives: Recent studies indicate the need to redefine renal function (RF) in acute heart failure (AHF) linking a rise in creatinine with clinical status to identify patients who develop evaluated the usefulness of serial assessment of urinary levels of neutrophil gelatinaseassociated lipocalin kidney injury molecule-1 (KIM-1). Materials and Methods: In 96 patients with AHF, uNGAL, uKIM-1, and uCysC were measured using a highly sensitive immunoassay based on a single-molecule counting technology (Singulex, Alameda, CA, USA) at baseline, day 2, and day 3. Patients who developed WRF (a ≥ 0.3 mg/dL increase in serum creatinine or a >25% decrease in the estimated glomerular filtration rate from the baseline value). Results: were differentiated into those presence of deterioration/no improvement in clinical status during hospitalization vs. 'pseudo-WRF' (uneventful clinical course). occurred in 12 (10%), 'pseudo-WRF' in 14 (11%), whereas the remaining 104 (79%) patients did not develop WRF. Patients with 'true WRF' were more often females, had higher levels of NT-proBNP, creatinine, and urea on admission, higher urine albumin to creatinine ratio at day 2, higher uNGAL at baseline, day 2, and day 3, and higher KIM-1 at day 2 (vs. pseudo-WRF vs. without WRF, all P<0.05). Patients with pseudo-WRF did not differ from those without WRF. In the multivariable model, elevated uNGAL at all time points and KIM-1 at day 2 remained independent predictors. Conclusion: identify patients at high risk of death. Larger studies with more frequent biomarker assessments in the early stages of hospitalization are needed to portray the dynamics of these patients in a realistic way, to better demonstrate the usefulness of biomarkers.
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Monoclonal gammopathy of unknown significance (MGUS) is a premalignant condition defined as the presence of a monoclonal protein with no evidence of plasma cell/B-cell-related malignancy. The risk of progression from MGUS to a related malignancy is approximately 1% per year. MGUS patients are closely monitored for signs of progression allowing for rapid initiation of treatment. In 2012, the International Kidney and Monoclonal Gammopathy Research Group (IKMG) introduced the term Monoclonal Gammopathy of Renal Significance (MGRS). MGRS is the clonal proliferation of a nephrotoxic monoclonal protein without meeting the criteria for any other plasma cell/B-cell malignancy. The diagnosis of MGRS allows for the initiation of urgent treatment required to prevent further deterioration in renal function. Updated diagnostic criteria from the IKMG made renal biopsy essential for diagnosis of MGRS. Consequently, the IKMG set out an algorithm to guide clinicians on when to consider a renal biopsy. The parameters measured to evaluate the need for a renal biopsy include urine albumin creatinine ratio (ACR). This audit was conducted in the Clatterbridge Cancer Centre Liverpool (CCC-L) a leading cancer centre in the Northwest of England. Urine ACR was chosen as the parameter to audit as it is a cheap, non-invasive, quantitative investigation. The primary outcome of this audit is to assess the number of MGUS patients who had an ACR measured at diagnosis in the Myeloma clinic from January 2014 to December 2020. Data were collected retrospectively from electronic clinic letters and notes. The date of diagnosis was defined as the date of clinic letter in which diagnosis was first confirmed. Patients were considered to have had an ACR performed at diagnosis if ACR was measured between 28 days prior to and post the date of diagnosis. ACR performed during disease was defined as any ACR measured from 28 days prior to date of diagnosis and date of death/data collection. Data from 503 patients (249 females, 254 males) were analysed. The median age at diagnosis was 73. Table 1 shows data for patients who had an ACR measurement performed at diagnosis and during disease. There is a trend towards greater compliance to measuring ACR at diagnosis in successive years from 2014 to 2019 (Table 1). This trend reverses in 2020 when only 40.0% of patients had an ACR measured at diagnosis. For all patients where ACR was performed during disease;56.8% ( n = 179) had the highest ACR measurement of <3.0 mg/mmol with only 14.0% ( n = 44) having the highest ACR measurement of >30.0 mg/mmol. If ACR was performed at diagnosis it was more commonly repeated if the value was higher;the frequencies with which ACR was repeated were 85.7% ( n = 12), 65.1% ( n = 28) and 28.4% ( n = 31) when ACR value at diagnosis was >30.0 mg/mmol, 3.0-30.0 mg/mmol and <3.0 mg/mmol respectively. This audit has shown an increased recognition for the importance of ACR measurement with increased compliance year on year. A likely hypothesis for the reduced measurements in 2020 is the need for remote clinic appointments during the Coronavirus 2019 (Covid-19) pandemic. Following IKMG guidelines 14.0% ( n = 44) of patients would be advised to have a renal biopsy due to their ACR measurement of >30.0 mg/ mmol. Further evaluation of this patient cohort is required to audit compliance with other parameters suggested by the IKMG. A diagnostic pathway to be used at the earliest opportunity for MGUS patients may then be developed..
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Frailty is a commonly occurring geriatric condition that increases the risk of adverse health outcomes. The factors and predictors behind frailty are not yet well understood. A better understanding of these factors can enable prevention of frailty in elderly patients. The objective of this study was to determine the association between proteinuria and frailty in US individuals with metabolic syndrome (MetS). Data from the National Health and Nutrition Examination Survey III (NHANES III, 1988-1994) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. This is a cross-sectional study, and proteinuria and frailty were measured only once at enrollment. The study included 2,272 participants with MetS aged 40-90 years from the NHANES III. The participants underwent assessments to evaluate frailty and frailty components (low body weight, weakness, exhaustion, low physical activity, and slow walking). Proteinuria was represented as albumin-to-creatinine ratio (ACR) (mg/g) and divided into tertiles: T1-normal range (ACR <30 mg/g), T2-microalbuminuria (ACR 30-299 mg/g), and T3-macroalbuminuria (ACR ≥ 300 mg/g). We applied multiple logistic regression to determine the odds ratios (ORs) of frailty for T2 vs. T1 and T3 vs. T1 in both sexes. In the adjusted analysis for male participants, the ORs of frailty for T2 and T3 vs. T1 were 3.106 (95% confidence interval [CI] = 1.078-8.948, P = 0.036) and 14.428 (95% CI = 4.231-49.193, P < 0.001), respectively. For female participants, the ORs of frailty for T2 and T3 vs. T1 were 1.811 (95% CI = 1.071-3.063, P = 0.027) and 2.926 (95% CI = 1.202-7.124, P = 0.018), respectively. The positive association between T2 and T3 vs. T1, and frailty were statistically significant. The trends of higher likelihood of every frailty component were also statistically significant across increasing tertiles of proteinuria after multiple levels of adjustment for covariates (P < 0.05). Increased proteinuria levels were positively associated with frailty and each frailty component. Proteinuria might be a useful maker for frailty in individuals with MetS.
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Frailty , Metabolic Syndrome , Proteinuria , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Frail Elderly , Frailty/epidemiology , Humans , Male , Metabolic Syndrome/epidemiology , Middle Aged , Nutrition Surveys , Proteinuria/epidemiologyABSTRACT
Introduction: Some patients with COVID-19 infection develop proteinuria or Acute Kidney Injury, and cases of COVID-19 related Collapsing Glomerulopathy have also been reported. Three published human kidney biopsy studies did not find viral particles in the glomeruli or tubules. This raises the possibility of glomerular and kidney injury induced by the extensive cytokine storm documented early on in the pandemic in hospitalized COVID-19 patients. Mutated forms of Human Angiopoietin-like 4 (protein 8520) were previously shown to reduce proteinuria in rat models of FSGS and diabetic nephropathy (Clement LC, Mace C et al. Nature Medicine 2014). Using different components or innate and adaptive immunity triggered during infection, we developed cytokine cocktails that mimic the COVID-19 cytokine storm, and tested the ability of protein 8520 to reduce glomerular injury in this model. Methods: After baseline urine and blood collections, two groups of BALB/c mice (mean n = 5 mice per group) were injected intravenously with dose 1.8 X of COVID Cocktail D. One hour later, they received 10 μg of His-Tag purified protein 8520 or control human albumin. Overall activity status was documented at 6 and 24 hours. At 24 hours after model induction, blood and urine samples were collected, and the mice euthanized, followed by harvesting of multiple organs including kidneys. Urine albumin was measured by ELISA (Bethyl Labs), and urine and serum creatinine by Mass Spectrometry. Results: Baseline urine albumin to creatinine ratio was similar between the two groups. At 24 hours, urine albumin to creatinine ratio was significantly lower in the 8520 treated compared to control treated group (P < 0.05). Serum creatinine on Day 1 was similar between both groups, and not significantly elevated compared to baseline. Kidney sections were processed for light and electron microscopy, and analysis of these studies is in progress. Conclusions: Treatment with recombinant mutated human Angiopoietin-like 4 reduces albuminuria in a mouse model of the COVID-19 cytokine storm. Further studies will be conducted to establish a potential therapeutic role in viral cytokine storms. No conflict of interest