Prevalence of renal involvement among pediatric patients hospitalized due to coronavirus disease 2019: A multicenter study

Abstract

Introduction. Renal involvement among pediatric patients with coronavirus disease 2019 ranges between 1.2% and 44%. Given the limited information available locally, the primary objective of this study was to estimate the prevalence of renal involvement in our setting. Population and methods. Cross-sectional study conducted in 13 Argentine sites between March and December 2020. Patients aged 1 month to 18 years hospitalized due to COVID-19 and with at least one measurement of serum creatinine and/or a urinalysis were included. Those with a known kidney disease were excluded. Renal involvement was defined as the presence of acute kidney injury (AKI), proteinuria, hematuria, leukocyturia and/or arterial hypertension (HTN). Results. Among 528 eligible medical records, 423 patients were included (55.0% were males; median age: 5.3 years). The clinical presentation was asymptomatic in 31%; mild, in 39.7%; moderate, in 23.9%; severe, in 1.2%; critical, in 0.7%; and 3.5% had multisystem inflammatory syndrome in children (MIS-C). Two patients (0.47%) died. The prevalence of renal involvement was 10.8% (95% confidence interval: 8.2-14.2); it was described as leukocyturia (16.9%), proteinuria (16.0%), hematuria (13.2%), HTN (3.7%), and AKI (2.3%). No patient required dialysis. Renal involvement was associated with severe forms of disease (p < 0.0001). Conclusion. The prevalence of renal involvement among pediatric patients hospitalized due to COVID-19 in 13 Argentine sites was 10.8%; severe forms of disease prevailed.

Urine Parameters in Patients with COVID-19 Infection

“…The incidence of these two parameters was not as high as in the previously mentioned studies; however, it can predict adverse renal outcomes in long-term follow-up since Omicron infections may cause new kidney involvement [45]. for GLU [7,8,11]; for LEU (a) severe and critical COVID-19 [7,8,42], (b) COVID-19 AKI [25]; for KET [16]; for SG [4,5,10,16]; for BLOOD (a) severe and critical COVID-19 [7,8,10,11,29], (b) COVID-19 AKI [16,22,44], (c) COVID-19 mortality [14,16].…”

“…Morell-Garcia et al [ 13 ], who analyzed 199 COVID-19 patients to find urine biomarkers associated with AKI and mortality, confirmed an increased presence of pathological casts in the urinary sediments of the patients requiring ICU admission. MicrExUrSed is an effective clinical tool to predict AKI, which is a severe complication of COVID-19 and could help to optimize diagnostic interventions [ 25 , 34 , 66 , 67 ].…”

“…In addition, the simultaneous increase in combined PRO and haematuria correlated with mortality in COVID-19 patients [12]. for GLU [7,8,11]; for LEU (a) severe and critical COVID-19 [7,8,42], (b) COVID-19 AKI [25]; for KET [16]; for SG [4,5,10,16]; for BLOOD (a) severe and critical COVID-19 [7,8,10,11,29], (b) COVID-19 AKI [16,22,44], (c) COVID-19 mortality [14,16].…”

“…Abbreviations: BLOOD, urine occult blood; PRO, proteinuria; GLU, glucose; LEU, leukocyturia; KET, ketones; SG, specific gravity; PH, potential of hydrogen. References: for PH [ 7 , 8 , 26 , 42 ]; for PRO (a) severe and critical COVID-19 [ 2 , 7 , 8 , 11 , 29 ], (b) COVID-19 AKI [ 25 ], (c) COVID-19 mortality [ 9 , 25 ]; for GLU [ 7 , 8 , 11 ]; for LEU (a) severe and critical COVID-19 [ 7 , 8 , 42 ], (b) COVID-19 AKI [ 25 ]; for KET [ 16 ]; for SG [ 4 , 5 , 10 , 16 ]; for BLOOD (a) severe and critical COVID-19 [ 7 , 8 , 10 , 11 , 29 ], (b) COVID-19 AKI [ 16 , 22 , 44 ], (c) COVID-19 mortality [ 14 , 16 ].…”