Kidney Problems Common in Children With COVID-19

By Reuters Staff

July 01, 2020

NEW YORK (Reuters Health) - Kidney dysfunction appears to be common among children and adolescents hospitalized with COVID-19, researchers in the UK report.

About 7% of adult COVID-19 patients experience acute kidney injury, according to early reports from Wuhan, China. But one Chinese study of 36 hospitalized pediatric patients with COVID-19 reported no cases of renal dysfunction.

Dr. Jelena Stojanovic and colleagues at Great Ormond Street Hospital for Children NHS Foundation Trust, in London, evaluated renal function in 52 pediatric patients (age, 0-16 years) admitted with SARS-CoV-2 infection.

Overall, 24 patients (46%) had a serum creatinine greater than the age-specific upper limit of reference interval (ULRI), and 15 patients (29%) met the British Association of Pediatric Nephrology diagnostic criteria for acute kidney injury.

All but one of the cases of acute kidney injury occurred in patients admitted to the pediatric ICU, and 11 cases occurred in those with pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2, the researchers report in The Lancet Child and Adolescent Health.

Only four patients with acute kidney injury had underlying comorbidities, and none was immunosuppressed.

Five of the 15 patients with acute kidney injury had abnormal ultrasound findings that showed enlarged kidneys.

None of the patients with acute kidney injury required kidney biopsy or continuous renal replacement therapy, and all but one case showed a decrease in serum creatinine to lower than the ULRI value during admission.

"Our data highlight the importance of renal function surveillance in all hospitalized pediatric cases of COVID-19, while simultaneously avoiding factors that exacerbate kidney injury, such as hypovolemia and the use of nephrotoxic drugs," the authors note. "Standard care should involve screening for nephritis and follow-up for long-term sequelae of acute kidney injury, such as hypertension and proteinuria."

"Further research should seek to compare SARS-CoV-2-positive pediatric patients against controls with other infectious causes of hypovolemic or hyperinflammatory shock to evaluate whether COVID-19 predisposes children and adolescents to a disproportionately higher risk of acute kidney injury," they add.

Dr. Stojanovic did not respond to a request for comments.

SOURCE: Lancet Child and Adolescent Health, online June 15, 2020.