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. 2022 Apr;37(4):849-857.
doi: 10.1007/s00467-021-05218-1. Epub 2021 Sep 14.

SARS-CoV-2 infection in children with chronic kidney disease

Sudarsan Krishnasamy  1 , Mukta Mantan  2 , Kirtisudha Mishra  3 , Kanika Kapoor  4 , Megha Brijwal  5 , Manish Kumar  3 , Shobha Sharma  4 , Swarnim Swarnim  2 , Rajni Gaind  6 , Priyanka Khandelwal  1 , Pankaj Hari  1 , Aditi Sinha  7 , Arvind Bagga  1
Affiliations

SARS-CoV-2 infection in children with chronic kidney disease

Sudarsan Krishnasamy et al. Pediatr Nephrol. 2022 Apr.

Abstract

Background: Information on the course of SARS-CoV-2 infection in children with chronic kidney disease (CKD) is limited.

Methods: We retrospectively reviewed the presentation and outcomes of SARS-CoV-2 infection in patients with CKD followed at any of the four pediatric nephrology centers in New Delhi from April 2020 to June 2021. Outcomes, including cardiopulmonary and renal complications, were reported in relation to underlying disease category and illness severity at presentation.

Results: Underlying illness in 88 patients included nephrotic syndrome (50%), other CKD stages 1-4 (18.2%), CKD 5D (17%), and CKD 5T (14.8%). Thirty-two of 61 patients with symptomatic COVID-19 and 9/27 asymptomatic patients were admitted for median 10 (interquartile range 7-15) days. Seventeen (19.3%) patients developed moderate or severe COVID-19. Systemic complications, observed in 30 (34.1%), included acute kidney injury (AKI, 34.2%), COVID-19 pneumonia (15.9%), unrelated pulmonary disease (2.3%), and shock (4.5%). Nineteen (21.6%) had severe complications (AKI stage 2-3, encephalopathy, respiratory failure, shock). Eight (11%) of twelve (16.4%) patients with severe AKI required dialysis. Three (3.4%) patients, two with steroid-resistant nephrotic syndrome in relapse and one with CKD 1-4, died due to respiratory failure. Univariate logistic regression indicated that patients presenting with nephrotic syndrome in relapse or moderate to severe COVID-19 were at risk of AKI (respective odds ratio, 95%CI: 3.62, 1.01-12.99; 4.58, 1.06-19.86) and/or severe complications (respective odds ratio, 95%CI: 5.92, 1.99-17.66; 61.2, 6.99-536.01).

Conclusions: Children with CKD presenting with moderate-to-severe COVID-19 or in nephrotic syndrome relapse are at risk of severe complications, including severe AKI and mortality. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Acute kidney injury; COVID-19; Children; Kidney replacement therapy; Nephrotic syndrome.

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Conflict of interest statement

The authors declare no competing interests.

Comment in

  • Response to Krishnasamy et al.
    Morello W, Vianello FA, Proverbio E, Montini G. Morello W, et al. Pediatr Nephrol. 2022 Mar;37(3):683. doi: 10.1007/s00467-021-05400-5. Epub 2022 Jan 10. Pediatr Nephrol. 2022. PMID: 35006351 Free PMC article. No abstract available.

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