POS-003 ACUTE KIDNEY INJURY IN CHILDREN WITH COVID-19 RELATED MULTISYSTEM INFLAMMATORY SYNDROME (MIS-C)

Abstract

Although children with coronavirus disease 19 (COVID-19) generally experience a mild disease, a subset of them develop multisystem inflammatory syndrome (MIS-C) which can lead to multiorgan failure. There is relative rarity of literature regarding acute kidney injury (AKI) in MIS-C. We aim to characterize the clinical features, laboratory findings, and therapies for AKI in MIS-C in our setup. This was a 1 ½ year prospective study with patients from GMC Srinagar, its associated hospitals and Shifa Medical Centre, Srinagar. Children <21 years old who had AKI and met the criteria for MIS-C based on CDC guidelines were included in the study. A total of seven cases were included in the study ranging from 4 to 20 years (mean 11.4±5) with 4 females and 3 males. Persistent fever was present in all patients. Six children had vomiting/diarrhea along with rashes and/or swelling of hands. Myocardial involvement was seen in four, respiratory in two and musculoskeletal in one patient. Oropharyngeal swab for SARS-Cov2 RNA was negative in all the patients. Anticovid antibodies were positive in five patients and two had a history of contact with COVID-19 patients. AKI Stage 1 was present in 3, stage 2 and 3 in 2 patients each. Neutrophilia with lymphopenia was seen in all the patients and thrombocytopenia in 4 patients. Laboratory findings for inflammatory markers showed marked elevation of C-reactive protein (mean 87.6±72.1mg/l), ferritin (mean 810±224ng/ml), procalcitonin (mean 4.9±2.1ng/ml), ESR (mean 64.6±21.9mm/hr), fibrinogen (690±142.1mg/dl), LDH (mean 578.2±370.1U/L) and D-Dimer (mean 7.8±9.4 µgFFU/ml). The patients were treated with a combination of steroids, IVIg and inotropic support wherever needed. All of the patients recovered with a median duration hospital stay of 7 (IQR 5) days. Children with covid 19 infection should be carefully followed for MIS-C. Although children with MIS-C develop AKI, most of them have full clinical recovery. The long term prognosis of this syndrome is currently unknown until their follow up data becomes available in future.