Acute Kidney Injury in Hospitalized Children with COVID19

Abstract

Background Acute kidney injury (AKI) has been recognized as a significant risk factor for mortality among adults with severe acute respiratory syndrome coronavirus infection. Aim The aim of this study is to assess the prevalence and risk factors for AKI and mortality in children with coronavirus disease 2019 (COVID19) from a resource-limited setting. Methods Cross-sectional analysis of laboratory confirmed COVID19 children admitted from 1 March to 30 November 2020 in a tertiary care hospital in New Delhi, India was done. Clinical features and associated comorbidities of COVID19 were noted. Baseline serum creatinine (height-independent Hoste’s equation) and peak serum creatinine were used for staging of AKI by the 2012 Kidney Disease Improving Global Outcomes serum creatinine criteria. Univariate analysis and Kaplan–Meier survival analysis were used to compare the overall outcome in the AKI vs. the non-AKI group. Results A total of 64 810 children between 1 month and 18 years visited the hospital; 3412 were tested for suspected COVID19, 295 tested positive and 105 (54% boys) were hospitalized. Twenty-four hospitalized children (22.8%) developed AKI; 8 in Stage 1 (33.3%), 7 in Stage 2 (29.2%) and 9 in Stage 3 (37.5%) respectively. Overall, three patients received KRT. Highest reported mortality was (66.6%) in AKI Stage 3. Risk factors for AKI included associated sepsis (OR 95% CI, 1.22-9.43, p < 0.01), nephrotic syndrome (OR 95% CI, 1.13-115.5, p < 0.01), vasopressor support (OR 3.59, 95% CI, 1.37–9.40, p value< 0.007), shock at presentation (OR 2.98, 95% CI, 1.16–7.60, p value 0.01) and mechanical ventilation (OR 2.64, 95% CI, 1.04–6.71, p value< 0.03). Mortality (25.71%) was higher in the AKI group (OR 95% CI, 1.14-8.35, p < 0.023) with shock (OR 45.92; 95% CI, 3.44–612.0, p value <0.004) and ventilation (OR 46.24; 95% CI, 1.6–1333.0 p value< 0.02) as significant risk factors for mortality. Conclusion AKI is an important modifiable risk factor for mortality in children with COVID19 in a resource-limited setting. Our study supports the strengthening of kidney replacement therapy and its timely initiation to reduce the progression of AKI and thus mortality in children.

Risk factors for poor prognosis in children and adolescents with COVID-19: A systematic review and meta-analysis

“…We identified 9937 potentially relevant records from the literature databases and registers, and 1575 records from the additional searches. After screening the titles, abstracts and full texts, 56 studies (22 cohort studies, 9 case-control studies, and 25 case series) with a total of 79,104 patients were included [ [10] , [11] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] ] ( Fig. 1 ).…”

“…A total of 26 studies assessed risk factors for death [ 11 , 23 , 24 , 26 , 27 , 29 , 33 , 34 , [37] , [38] , [39] , [40] , [46] , [47] , [48] , 50 , 57 , 58 , 60 , 63 , 68 , 70 , [72] , [73] , [74] , [75] ]. We found low quality evidence that acute kidney injury (AKI, OR =3.15, 95% CI 1.25 to 7.90, two studies) was associated with an elevated risk of death.…”

“…A total of 16 studies assessed risk factors for receiving respiratory support [ [26] , [27] , [28] , [29] , [30] , 32 , 33 , 37 , 42 , 43 , 47 , 56 , 58 , 65 , 68 , 70 ] including mechanical ventilation, conventional oxygen therapy. According to the results of meta-analysis, neurological diseases ( OR =2.51, 95% CI 1.03 to 6.15, one study) and having shortness of breath ( OR =16.96, 95% CI 7.66 to 37.51, one study) were associated with an increased odds of respiratory support (low-quality evidence).…”

Clinical profile and outcomes of COVID-19 patients with acute kidney injury: a tertiary centre experience from South India

“…India now has one of the highest number of reported cases of COVID-19, second only to the United States of America [ 4 ]. Despite this, data from India regarding prevalence and outcomes of AKI in COVID-19 are sparse [ 5 – 8 ]. We aimed to study the prevalence of AKI in hospitalised patients with COVID-19 and their outcomes at a tertiary care centre in India.…”

Child with new onset nephrotic syndrome as the sole manifestation of SARS‐CoV‐2 infection

“…Renal involvement during COVID‐19 infection is not at all common within paediatric population. Among 295 children hospitalised with COVID‐19 in a recent study, proteinuria and gross hematuria were seen in 4.76% and 1.9% of cases, respectively 7 . Current literature is referring mainly to hospitalised children with severe COVID‐19 pneumonia and AKI.…”