Pathology findings in pediatric patients with COVID-19 and kidney dysfunction

Nomura, Eric C; Finn, Laura S.; Bauer, Abbie; Rozansky, David J.; Iragorri, Sandra; Jenkins, Randall; Al‐Uzri, Amira; Richardson, Kelsey; Wright, Mary Jo; Kung, Vanderlene L.; Troxell, Megan L.; Andeen, Nicole K.

doi:10.1007/s00467-022-05457-w

Cited by 16 publications

(19 citation statements)

References 34 publications

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“…Recent studies have documented various kidney complications that occur after a COVID-19 infection in children. Nomura et al 2 reported on a multi-institutional cohort of five unvaccinated pediatric patients with COVID-19 and associated kidney dysfunction with histological descriptions. Three patients with COVID-19 had multifactorial thrombotic microangiopathy with clinical features of hemolytic uremic syndrome (n = 2) or disseminated intravascular coagulation (n = 1).…”

Section: Discussionmentioning

confidence: 99%

De Novo Crescentic Glomerulonephritis Following COVID-19 Infection: A Pediatric Case Report

et al. 2023

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As the global coronavirus disease 2019 (COVID-19) pandemic continues to sweep across the globe, reports of kidney involvement in adult patients infected with COVID-19 have been documented, and recently, cases in the pediatric population have also been reported. This report highlights the case of an 11-year-old boy who developed acute kidney injury presenting as gross hematuria, proteinuria, and hypertension immediately after a COVID-19 infection. A renal biopsy allowed us to diagnose the patient with post-COVID-19 infection-associated de novo crescentic immune-mediated glomerulonephritis. Oral prednisolone and cyclophosphamide treatments were initiated after methylprednisolone pulse therapy administration. Currently, the patient is receiving medical treatment for five weeks, and his renal function is gradually recovering. Previous studies have suggested that, although quite rare, a variety of kidney complications can occur after COVID-19 infection or vaccination, and it is recommended to monitor renal function through evaluation. Herein, we report a pediatric case of post-COVID-19 infection-associated de novo crescentic immune-mediated glomerulonephritis consistent with rapidly progressive glomerulonephritis.

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Section: Discussionmentioning

confidence: 99%

De Novo Crescentic Glomerulonephritis Following COVID-19 Infection: A Pediatric Case Report

et al. 2023

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“…A statistically significant conclusion could not be drawn from the local cohort as the sample number is small. With the recent global outbreak of covid‐19, it was observed that covid‐19 infection was also associated with TMA in both adult and pediatric populations 46,47 . Patients in post‐HSCT settings are of no exception at risk of covid‐19‐induced TMA when they get infected, which further complicates the clinical picture of TA‐TMA due to various causes described above.…”

Section: Discussionmentioning

confidence: 99%

“…With the recent global outbreak of covid-19, it was observed that covid-19 infection was also associated with TMA in both adult and pediatric populations. 46,47 Patients in post-HSCT settings are of no exception at risk of covid-19-induced TMA when they get infected, which further complicates the clinical picture of TA-TMA due to various causes described above. Published reports described success in using eculizumab in treating covid-19induced TMA.…”

Section: Pathogenesis Risk Factors and Preventionmentioning

confidence: 99%

Epidemiology and outcomes of pediatric transplant‐associated thrombotic microangiopathy in Hong Kong

Chan

Tak²,

Chan³

et al. 2022

Pediatric Transplantation

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Background: Transplant-associated thrombotic microangiopathy (TA-TMA) is an under-recognized yet potentially devastating complication of hematopoietic stem cell transplantation (HSCT) which had increased awareness in recent years. This report summarizes the demographics and outcomes of pediatric TA-TMA in Hong Kong. Methods: All patients aged below 18 years who underwent HSCT in the Hong Kong Children's Hospital and were diagnosed to have TA-TMA during the 2-year period from April 1, 2019 to March 31, 2021 were included.Results: A total of 73 transplants (51 allogeneic and 22 autologous) in 63 patients had been performed. Six patients (four males and two females) developed TA-TMA at a median duration of 2.5 months post-HSCT. The incidence rate was 9.52%. Of the six TA-TMA patients, five underwent allogenic one underwent autologous HSCT, respectively. Three of them were histologically proven. All four patients with cyclosporine had stopped the drug once TA-TMA was suspected. Median six doses of eculizumab were administered to five out of six patients. Three patients died (two due to fungal infection and one due to acute-on-chronic renal failure) within 3 months upon diagnosis of TA-TMA. Among three survivors, two stabilized with mild stage 2 chronic kidney disease (CKD) while the other suffered from stage 5 end-stage CKD requiring lifelong dialysis. Conclusion:In conclusion, recognition and diagnosis of TA-TMA are challenging. Early recognition and prompt administration of complement blockage with eculizumab may be beneficial in selected cases. Further prospective research studies are recommended to improve the management and outcomes of TA-TMA.

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“…Taken together, studies with kidney organoids support the direct viral infection hypothesis, with proximal tubular epithelial cells representing the primary target of SARS-CoV-2. However, many studies from groups across the world have found no evidence of viral infection in kidney biopsies from COVID-19 patients with renal dysfunction using rigorous ultrastructural criteria of coronavirus identification corroborated by ISH and/or IHC (Table 2 ) [ 2 , 3 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ].…”

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confidence: 99%

Kidney Disease and Viral Infection in COVID-19: Why Are Kidney Organoid and Biopsy Studies Not in Agreement?

Nicosia

2023

Nephron

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Context: The clinical course of coronavirus disease-19 (COVID-19) can be complicated by acute kidney injury and proteinuria. Kidney cells express receptors for SARS-CoV-2, the virus responsible for COVID-19. Direct infection of the kidney parenchyma by SARS-CoV-2 has been proposed as the cause of renal dysfunction in COVID-19. Subject of Review: Kidney organoids derived from human embryonic stem cells or induced pluripotent cells can be reproducibly infected by SARS-CoV-2 in vitro and used to study therapeutics. However, kidney biopsy studies of COVID-19 patients with renal dysfunction have shown no evidence of viral infection. Second Opinion: Kidney organoids are susceptible to SARS-CoV-2 infection, which is probably facilitated by their limited architectural complexity and maturation compared to the intact organ and by the in vitro culture conditions. Conversely, kidneys in COVID-19 patients appear resistant to infection and may be injured through indirect mechanisms mediated by the host response to the respiratory viral infection, genetic susceptibility to the immune response, physiological disturbances, and therapies. More studies are needed to better understand why kidney organoids are more susceptible than mature kidneys to SARS-CoV-2 infection and further characterize the mechanisms of kidney injury in COVID-19.

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Pathology findings in pediatric patients with COVID-19 and kidney dysfunction

Cited by 16 publications

References 34 publications

De Novo Crescentic Glomerulonephritis Following COVID-19 Infection: A Pediatric Case Report

De Novo Crescentic Glomerulonephritis Following COVID-19 Infection: A Pediatric Case Report

Epidemiology and outcomes of pediatric transplant‐associated thrombotic microangiopathy in Hong Kong

Kidney Disease and Viral Infection in COVID-19: Why Are Kidney Organoid and Biopsy Studies Not in Agreement?

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