Acute kidney injury in children with COVID-19: a retrospective study

Abstract

Background Acute kidney injury (AKI) is a complication of coronavirus disease 2019 (COVID-19). The reported incidence of AKI, however, varies among studies. We aimed to evaluate the incidence of AKI and its association with mortality and morbidity in children infected with severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) who required hospital admission. Methods This was a multicenter retrospective cohort study from three tertiary centers, which included children with confirmed COVID-19. All children were evaluated for AKI using the Kidney Disease Improving Global Outcomes (KDIGO) definition and staging. Results Of 89 children included, 19 (21 %) developed AKI (52.6 % stage I). A high renal angina index score was correlated with severity of AKI. Also, multisystem inflammatory syndrome in children (MIS-C) was increased in children with AKI compared to those with normal kidney function (15 % vs. 1.5 %). Patients with AKI had significantly more pediatric intensive care admissions (PICU) (32 % vs. 2.8 %, p < 0.001) and mortality (42 % vs. 0 %, p < 0.001). However, AKI was not associated with prolonged hospitalization (58 % vs. 40 %, p = 0.163) or development of MIS-C (10.5 % vs. 1.4 %, p = 0.051). No patient in the AKI group required renal replacement therapy. Residual renal impairment at discharge occurred in 9 % of patients. This was significantly influenced by the presence of comorbidities, hypotension, hypoxia, heart failure, acute respiratory distress, hypernatremia, abnormal liver profile, high C-reactive protein, and positive blood culture. Conclusions AKI occurred in one-fifth of children with SARS-CoV-2 infection requiring hospital admission, with one-third of those requiring PICU. AKI was associated with increased morbidity and mortality, and residual renal impairment at time of discharge.

COVID-19 pandemic and kidney disease in children: literature review and own regional observations

“…ОПП не потребовало ЗПТ, однако остаточная почечная недостаточность наблюдалась при выписке у 9% пациентов. На это повлияли сопутствующие заболевания: артериальная гипертензия, гипоксия, сердечная недостаточность [13].…”

Analysis of Vascular Architecture and Parenchymal Damage Generated by Reduced Blood Perfusion in Decellularized Porcine Kidneys Using a Gray Level Co-occurrence Matrix

“…The incidence of kidney failure, otherwise known as endstage renal disease Zambon et al is rising globally (1,2). Unfortunately, there is no cure for this condition, which can develop form the progression of acute and chronic injuries (3)(4)(5).…”

Can microalbuminuria be an ındicator of renal ınvolvement in pediatric Covid 19 patients?

“…Although rare when compared to adult counterparts there are studies addressing renal involvement also in children with COVID 19; mainly evaluating the presence of AKI and its relation with prognosis [6][7][8][9]. In an early study by Stewart et al 24 (46%) out of 52 pediatric patients hospitalized with COVID 19, had a serum creatinine level greater than upper limit of reference interval (ULRI) [7].…”

“…The reported incidence of AKI ranged from 0 to 70% in different pediatric studies [6]. These discrepancies among studies were attributed to different definitions of AKI and different cohorts [6][7][8][9][10]. Hematuria and proteinuria are well recognized in adult studies but to our knowledge in children there are only anecdotal reports describing new onset hematuria and/or proteinuria or nephrotic syndrome in pediatric patients with COVID 19 [10][11][12][13][14].…”