Abstract
Objective: To evaluate the prevalence and factors associated with the risk of acute kidney injury (AKI) in pediatric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem inflammatory syndrome in children (MIS-C).Study Design: We performed a retrospective chart review of 113 patients with SARS-CoV-2 infection with or without MIS-C admitted at Children's Hospital of Michigan (CHM) from March to August 2020. Patient demographic details, laboratory data, imaging studies, echocardiography reports, and treatment data were collected.Results: Of the 92 patients included in the final analysis, 22 (24%) developed AKI with 8/22 (36%) developing stage 3 AKI. The prevalence of AKI was much higher in patients with MIS-C 15/28 (54%) vs. those with acute SARS-CoV-2 infection 7/64 (11%), (p < 0.001). Overall, when compared to patients without AKI, patients with AKI were older in age (11 vs. 6.5 years, p = 0.007), African American (86 vs. 58%, p = 0.028), had MIS-C diagnosis (68 vs. 19%, p < 0.001), required ICU admission (91 vs. 20%, p < 0.001), had cardiac dysfunction (63 vs. 16%, p < 0.001), required inotropic support (59 vs. 6%, p < 0.001) and had a greater elevation in inflammatory markers. In a multivariate analysis, requirement of inotropes [Odds Ratio (OR)−22.8, p < 0.001], African American race (OR-8.8, p = 0.023) and MIS-C diagnosis (OR-5.3, p = 0.013) were the most significant predictors for AKI. All patients had recovery of kidney function, and none required kidney replacement therapy.Conclusion: Children with acute SARS-CoV-2 infection and MIS-C are at risk for AKI, with the risk being significantly greater with MIS-C. The pathogenesis of AKI in acute SARS-CoV-2 infection appears to be a combination of both renal hypo-perfusion and direct renal parenchymal damage whereas in MIS-C, the renal injury appears to be predominantly pre-renal from cardiac dysfunction and capillary leak from a hyperinflammatory state. These factors should be considered by clinicians caring for these children with a special focus on renal protective strategies to aid in recovery and prevent additional injury to this high-risk subgroup.
Highlights
Acute kidney injury (AKI) in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been increasingly recognized and is associated with increased morbidity in adults
The prevalence of AKI in pediatric patients with SARS-CoV-2 infection is variable with reported rates ranging from 18 to 29% in hospitalized children [1,2,3]; a higher prevalence has been reported in critically ill children approaching 44% according to a recent multi-center cross sectional analysis [4]
Patients with signs and symptoms of multisystem inflammatory syndrome in children (MIS-C) with negative reverse transcriptase-polymerase chain reaction (RT-PCR) results and negative or unknown SARS CoV-2 IgG antibody test results were considered positive if an epidemiological link to patient with suspected or confirmed SARS-CoV-2 infection occurred within 4 weeks prior to onset of symptoms
Summary
Acute kidney injury (AKI) in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been increasingly recognized and is associated with increased morbidity in adults. The prevalence of AKI in pediatric patients with SARS-CoV-2 infection is variable with reported rates ranging from 18 to 29% in hospitalized children [1,2,3]; a higher prevalence has been reported in critically ill children approaching 44% according to a recent multi-center cross sectional analysis [4]. We conducted a retrospective chart review of pediatric patients with SARS-CoV-2 infection with or without MIS-C admitted to our hospital during the initial surge of the COVID-19 pandemic. We evaluated the prevalence of AKI and studied the factors associated with the risk of AKI in these patients To our knowledge this is the largest single center cohort reporting the prevalence and factors associated with the risk of AKI in pediatric patients with SARS-CoV-2 infection and MIS-C
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