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. 2021 Jul;100(1):138-145.
doi: 10.1016/j.kint.2021.02.026. Epub 2021 Mar 3.

Acute kidney injury in pediatric patients hospitalized with acute COVID-19 and multisystem inflammatory syndrome in children associated with COVID-19

Abby Basalely  1 , Shari Gurusinghe  2 , James Schneider  3 , Sareen S Shah  3 , Linda B Siegel  3 , Gabrielle Pollack  4 , Pamela Singer  5 , Laura J Castellanos-Reyes  5 , Steven Fishbane  6 , Kenar D Jhaveri  6 , Elizabeth Mitchell  7 , Kumail Merchant  5 , Christine Capone  8 , Ashley M Gefen  5 , Julie Steinberg  5 , Christine B Sethna  5
Affiliations

Acute kidney injury in pediatric patients hospitalized with acute COVID-19 and multisystem inflammatory syndrome in children associated with COVID-19

Abby Basalely et al. Kidney Int. 2021 Jul.

Abstract

This study describes the incidence, associated clinical characteristics and outcomes of acute kidney injury in a pediatric cohort with COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C). We performed a retrospective study of patients 18 years of age and under admitted to four New York hospitals in the Northwell Health System interned during the height of the COVID-19 pandemic, between March 9 and August 13, 2020. Acute kidney injury was defined and staged according to Kidney Disease: Improving Global Outcomes criteria. The cohort included 152 patients; 97 acute-COVID-19 and 55 with MIS-C associated with COVID-19. Acute kidney injury occurred in 8 with acute-COVID-19 and in 10 with MIS-C. Acute kidney injury, in unadjusted models, was associated with a lower serum albumin level (odds ratio 0.17; 95% confidence interval 0.07, 0.39) and higher white blood cell counts (odds ratio 1.11; 95% confidence interval 1.04, 1.2). Patients with MIS-C and acute kidney injury had significantly greater rates of systolic dysfunction, compared to those without (80% vs 49%). In unadjusted models, patients with acute kidney injury had 8.4 days longer hospitalizations compared to patients without acute kidney injury (95% confidence interval, 4.4-6.7). Acute kidney injury in acute-COVID-19 and MIS-C may be related to inflammation and/or dehydration. Further research in larger pediatric cohorts is needed to better characterize risk factors for acute kidney injury in acute-COVID-19 and with MIS-C consequent to COVID-19.

Keywords: COVID-19; SARS-CoV-2; acute kidney injury; pediatric nephrology.

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Figures

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Graphical abstract
Figure 1
Figure 1
Flowchart of study population. Acute kidney injury (AKI) was staged by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. CCMC, Cohen Children’s Medical Center; COVID-19, coronavirus disease 2019; LH, Lenox Hill Hospital; MIS-C, multisystem inflammatory syndrome in children; SI, Staten Island University Hospital; SS, Southside Hospital.
Figure 2
Figure 2
Acute kidney injury (AKI) by day of hospitalization. COVID, acute coronavirus disease 2019; MIS-C, multisystem inflammatory syndrome in children.
See this image and copyright information in PMC

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References

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Supplementary concepts