Critical analysis of acute kidney injury in pediatric COVID-19 patients in the intensive care unit

Abstract

Background and objectives COVID-19 is responsible for the 2019 novel coronavirus disease pandemic. Despite the vast research about the adult population, there has been little data collected on acute kidney injury (AKI) epidemiology, associated risk factors, treatments, and mortality in pediatric COVID-19 patients admitted to the ICU. AKI is a severe complication of COVID-19 among children and adolescents. Methods A comprehensive literature search was conducted in PubMed/MEDLINE and Cochrane Center Trials to find all published literature related to AKI in COVID-19 patients, including incidence and outcomes. Results Twenty-four studies reporting the outcomes of interest were included. Across all studies, the overall sample size of COVID positive children was 1,247 and the median age of this population was 9.1 years old. Among COVID positive pediatric patients, there was an AKI incidence of 30.51%, with only 0.56% of these patients receiving KRT. The mortality was 2.55% among all COVID positive pediatric patients. The incidence of multisystem inflammatory syndrome in children (MIS-C) among COVID positive patients was 74.29%. Conclusion AKI has shown to be a negative prognostic factor in adult patients with COVID-19 and now also in the pediatric cohort with high incidence and mortality rates. Additionally, our findings show a strong comparison in epidemiology between adult and pediatric COVID-19 patients; however, they need to be confirmed with additional data and studies.

Acute Kidney Injury in Children Hospitalized with SARS-CoV-2 Infection

“…We observed that AKI incidence in children with acute COVID-19 is almost similar to critically sick children admitted for other illnesses [ 1 ]. A similar incidence of AKI is also reported in adults with COVID-19 [ 3 , 4 ]. Considering a significant proportion of children with SARS-CoV-2 infection developing AKI, clinicians should be watchful and take pre-emptive measures for prevention.…”

COVID‐19‐associated rhabdomyolysis in a paediatric patient with sickle cell trait

“…AKI is one of the most common complications of COVID-19 and is estimated to occur in up to 30% of paediatric patients. 2 The aetiology is probably multifactorial but includes cytokine storm, macrophage and complement activation; endothelial dysfunction; and direct viral infection of podocytes and tubular cells. There are very few reports, however, of children with COVID-19 developing AKI secondary to rhabdomyolysis.…”

“…The increasing severity of the myalgia however triggered further investigation and the identification of a significant AKI. AKI is one of the most common complications of COVID‐19 and is estimated to occur in up to 30% of paediatric patients 2 . The aetiology is probably multifactorial but includes cytokine storm, macrophage and complement activation; endothelial dysfunction; and direct viral infection of podocytes and tubular cells.…”

Incidence, risk factors and outcomes of acute kidney injury among COVID-19 patients: A systematic review of systematic reviews

“…Most of the reviews excluded studies with < 10 patients, published in languages other than English, and on specialized populations i.e., children, pregnant women, and patients with cancer and CKD. One review was conducted on the pediatrics population (44), while five studies included KTRs in data synthesis (21,31,34,36,37). All the reviews did not include animal studies, and most of the reviews excluded case reports, except five studies (1,11,13,21,45).…”