Renal and testicular involvement in COVID-19 patients - implication for the urologist.

Abstract

Angiotensin-converting enzyme II (ACE2), the cellular receptor for SARS-CoV-2, is widely distributed in the urogenital system, including proximal renal tubular cells, urothelial bladder cells, Leydig cells, and cells in seminiferous ducts. Thus, the potential direct insults in COVID-19 patients include acute kidney injury (AKI), hypogonadism, and infertility. The implications of SARS-CoV-2 being isolated from urine include potential transmission through urine and the possibility of a urine-based noninvasive diagnostic test. Viral shedding in urine may be a result of cytokine storm-induced renal dysfunction or direct invasion by binding to ACE2 receptors. Emphasis is made about the cadre of urological patients at increased risk of COVID-19, including those with urological malignancies and chronic kidney disease, especially dialysis-dependent patients. These patients have increased susceptibility to infection and also higher mortality due to decreased immunity. As such, the implications of the COVID-19 pandemic for a urologist is underscored.