Relapse rate of nephrotic syndrome in the time of COVID-19

Harambat, Jérôme; Allard, Lise; Godron-Dubrasquet, Astrid

doi:10.1007/s00467-020-04814-x

Cited by 13 publications

(10 citation statements)

References 3 publications

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“…Our multicentric retrospective study shows that, during the first year of the SARS-COV-2 pandemic, the incidence of relapses was not statistically different when compared to the previous 5 years. These results are in line with the data presented by Harambat et al [20], who did not find any increase in the relapse rate during the first COVID-19 wave in a cohort of 111 INS children, when compared to the same period of the previous year [20]. Furthermore, Crane et al reported a statistically significant lower relapse rate during the pandemic as compared to the previous 5 years, speculating that this difference could be related to the decreased rates of viral infections [24].…”

Section: Discussionsupporting

confidence: 94%

“…Our findings corroborate the fact that, although SARS-CoV-2 is a potential trigger for relapses [ 4 , 5 , 20 ], restrictive measures and the consequent decline of upper viral respiratory infections may have counterbalanced the effect of the pandemic on the risk of relapse [ 25 ]. Indeed, in Italy and Belgium a nationwide lockdown was imposed between March and May 2020 and severe restrictions such as curfew and the closure of public services like malls and parks were restored in November.…”

Section: Discussionsupporting

confidence: 84%

“…Relapses have been documented in children with INS during SARS-CoV-2 infection [ 18 , 19 ]. However, the only available study reported no increase in relapse rates during the first months of the pandemic [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Relapse rate in children with nephrotic syndrome during the SARS-CoV-2 pandemic

et al. 2022

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Background Viral upper respiratory tract infections trigger nephrotic syndrome relapses. Few data exist on the impact of the SARS-CoV-2 pandemic on the risk of relapse in children with idiopathic nephrotic syndrome (INS). Methods In a Belgian and Italian cohort of children with INS, we performed a retrospective analysis on the number and duration of relapses observed in 3 different periods in 2020: first COVID period, February 15–May 31; second COVID period, June 1–September 14; third COVID period, September 15–December 31. Relapse rates were compared to those of the previous 5 years (PRECOVID period). For the years 2019 and 2020, all causes and INS relapse-related hospitalizations were recorded. Hospitalizations and deaths due to SARS-CoV-2 infection were also recorded. In the Belgian cohort, SARS-CoV-2 serologies were performed. Results A total of 218 patients were enrolled, and 29 (13.3%) were diagnosed with new-onset INS during the COVID period. Relapse rates per 1000 person-days were as follows: 3.2 in the PRECOVID period, 2.7 in the first COVID period, 3.3 in the second COVID period, and 3.0 in the third COVID period. The incidence rate ratio for the total COVID period was 0.9 (95%CI 0.76 to 1.06; P = 0.21) as compared to the PRECOVID period. During 2020, both the proportion of patients hospitalized for recurrence (14.2% vs. 7.6% in 2019; P = 0.03) and the rate of hospitalization for recurrence (IRR 1.97 (95%CI 1.35 to 2.88); P = 0.013) were higher compared to 2019. In December 2020, anti-SARS-CoV-2 antibodies were detected in 31% of the Belgian cohort. Patients with positive and negative SARS-CoV-2 serology did not differ significantly in relapse rate (2.4 versus 4.2 per 1000 person-days). The number of new INS cases remained similar between 2020, 2019, and 2018. Conclusion The first year of the SARS-CoV-2 pandemic did not significantly affect the relapse rate in children with INS. No serious infections were reported in this population of immunosuppressed patients. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information Supplementary Information The online version contains supplementary material available at 10.1007/s00467-022-05702-2.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 84%

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Relapse rate in children with nephrotic syndrome during the SARS-CoV-2 pandemic

et al. 2022

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“…In a study on 113 children with kidney diseases receiving immunosuppressive medications from 30 countries; authors found that only 9.7% had severe grade of disease [3]. Features of relapse, or new organ involvement (pancreas) or new onset glomerulonephritis have been seen in children with nephrotic syndrome in present study and this might be like other viruses, SARS Co-V-2 infection may also precipitate relapses or infect new organ [9,10].…”

supporting

confidence: 50%

Clinical Profile and Outcome of COVID-19 Among Immunocompromised Children

et al. 2021

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children manifests as mild to moderate disease with low fatality [1]. There is limited information about susceptibility to SARS-CoV-2 infection, clinical profile and outcome among immunocompromised children in India. Published literature has revealed milder disease and favorable outcome without discontinuation of immunosuppressive medication in these children [2][3][4][5][6]. We, herein describe the clinical features and outcome of immunocompromised children diagnosed with SARS-CoV-2 infection at our center.This was a retrospective analysis of data from 1 June to 31 October, 2020 at a tertiary care center of a teaching hospital. The analysis was approved by institutional ethics committee. All children admitted during the study period were screened for SARS-CoV-2 infection and those who were diagnosed with coronavirus disease 19 (COVID-19) were classified into immunocompromised and immunocompetent. All immunocompromised children in the present study were either on anticancer drugs or immunosuppressive therapy for kidney diseases, and fulfilling criteria for immunocompromised state [6]. The variables extracted from the hospital records were age, gender, presenting symptoms, complications, severity of illness, diagnosis, laboratory investigations, imaging findings, treatment and outcome. The diagnosis of COVID-19 was made by positive reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2. The severity of illness was classified as per guidelines given by Ministry of Health and Family Welfare, Government of India [7], and children were treated as per unit protocol without alteration in immunosuppressive treatment regime. Proportions were compared using Fisher exact test.

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“…In a French national study by Harambat et al retrospectively comparing the number of relapses in children with INS from March 16 to August 30, 2020 (0.78 relapse/patient-year), with the same period in 2019 (0.91 relapse/patient-year), the risk of relapse was not increased during the COVID-19 pandemic [ 17 ]. Nonetheless, no SARS-CoV-2 infections were identified.…”

Section: Resultsmentioning

confidence: 99%

COVID-19 and idiopathic nephrotic syndrome in children: systematic review of the literature and recommendations from a highly affected area

et al. 2021

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Background Coronavirus Disease 2019 has spread from China as a global pandemic, Italy being one of the earliest affected countries. The infection displays a more complicated and often fatal course in adults with a history of kidney disease, while it does not seem to affect children in the same way. Pediatric patients with idiopathic nephrotic syndrome (INS), with or without chronic immunosuppressive therapy, are at greater risk of infections which may also trigger relapses. Objectives We performed a systematic review of the literature to identify all articles on SARS-CoV-2 infections in children with INS in order to describe the severity of all SARS-CoV-2 infections reported in children with INS, to evaluate the risk of new onset and relapses associated with SARS-CoV-2 infection, and to draw recommendations on their management and vaccination. The search was conducted on the following databases: MEDLINE (via Pubmed), Google Scholar, and Web of Science. The search methodology used with the selected free text terms or MesH was (“nephrotic syndrome” OR “idiopathic nephrotic syndrome”) and (“covid 19” OR "severe acute respiratory syndrome coronavirus 2" OR "2019-nCoV" OR "SARS-CoV-2"). Results The literature search provided 36 records. After screening for their relevance to the topic, 11 studies were selected. Two additional publications were identified through the reference list of all included articles and 13 articles were included in the review. A total of 43 cases of children with INS and SARS-CoV-2 infection have been reported; the course of the disease was mild for most patients with low need of respiratory support and no death in high income countries. In 5 patients, the infection was complicated by relapse, which anyway showed a good response to steroids. Two children had a new onset of INS during a SARS-CoV-2 infection. Conclusions Children with INS, with or without immunosuppression, are not at higher risk of severe SARS-CoV-2 infection. Relapse is a possible complication, but steroid treatment is safe and effective. After summarizing the evidence, we have suggested recommendations for the management of children with INS during the pandemic and the vaccination campaign. Graphical abstract

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Relapse rate of nephrotic syndrome in the time of COVID-19

Cited by 13 publications

References 3 publications

Relapse rate in children with nephrotic syndrome during the SARS-CoV-2 pandemic

Relapse rate in children with nephrotic syndrome during the SARS-CoV-2 pandemic

Clinical Profile and Outcome of COVID-19 Among Immunocompromised Children

COVID-19 and idiopathic nephrotic syndrome in children: systematic review of the literature and recommendations from a highly affected area

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