Acute kidney injury in critically Ill children and young adults with suspected SARS-CoV2 infection

A retrospective analysis of acute kidney injury in children with post-COVID-19 multisystem inflammatory syndrome: insights into promising outcomes

BACKGROUND

Acute kidney injury (AKI) in patients with multisystem inflammatory syndrome (MIS), COVID-19 related infection has been increasingly recognized with a paucity of data on AKI incidence, related mortality, and the requirement of renal replacement therapy in children with MIS (MIS-C).

METHODS

This is a retrospective study evaluating the prevalence, severity, management and outcomes of AKI in a cohort of Egyptian children with MIS-children (MIS-C) post-COVID infection. Patients were included if they met the criteria for MIS-C based on CDC guidelines. All patients were evaluated for AKI diagnosis and staging according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria.

RESULTS

Between March 2021 and June 2023, a total of 655 confirmed COVID-19 cases were admitted and then followed up in our hospital, of whom 138 (21%) were diagnosed with MIS-C. Fifty-one patients developed AKI associated with MIS-C post-COVID infection, 42 of whom were included in the analysis. Thirty-one patients had AKI in a formerly healthy kidney, of whom 51% (16 patients) were classified as KDIGO stage 3, 5 patients needed hemodialysis and 13 needed mechanical ventilation. Higher WBCs count, and serum ferritin on admission were associated with more severe AKI (KDIGO stage 3) (p = 0.04), while multivariate analysis showed high serum ferritin to be independent predictor of more severe AKI (p = 0.02). Two patients (2/31) died during hospital admission, while no residual renal impairment was reported at the time of discharge of patients with previously normal kidney functions.

CONCLUSION

More than one-third of patients with MIS-C develop AKI. Avoidance of nephrotoxic drugs, early recognition, and prompt management of AKI, including well-timed commencement of dialysis in MIS-C cases, is associated with favorable outcomes.

Kidney complications associated with COVID-19 infection and vaccination in children and adolescents: a brief review

Coronavirus disease 2019 (COVID-19) has spread considerably across the globe, affecting numerous children and adolescents besides adults. Despite its relatively lower incidence rates in children and adolescents than in adults, some infected children and adolescents exhibit a severe postinflammatory response known as multisystem inflammatory syndrome in children, followed by acute kidney injury, a common complication. Meanwhile, few reports have been available regarding kidney complications such as idiopathic nephrotic syndrome and other glomerulopathies associated with COVID-19 infection and vaccination in children and adolescents. However, the morbidity and mortality of these complications are not exceptionally high; more importantly, causality has yet to be clearly established. Finally, vaccine hesitancy in these age groups should be addressed, considering the strong evidence of COVID-19 vaccine safety and efficacy.

Incidence of Acute Kidney Injury in Hospitalized Children: A Meta-analysis

BACKGROUND AND OBJECTIVES

There is limited literature on the incidence of acute kidney injury (AKI) and associated mortality in hospitalized children. To systematically assess the worldwide incidence of AKI in hospitalized children to inform policymakers regarding appropriate health resource allocation.

METHODS

Three different databases were searched (PubMed, Embase, Web of Sciences) from March 2012 to January 2022 without language or geographical restrictions. We included cohort and cross-sectional studies that reported AKI incidence in hospitalized children. Eligible studies had at least 100 participants and used the standard Kidney Disease Improving Global Outcomes criteria to define AKI. Two authors extracted data on the study and patients' characteristics and outcomes (incidence and AKI-associated mortality) and performed the risk of bias assessment. We used a random-effects meta-analysis to generate pooled estimates.

RESULTS

We included 94 studies (202 694 participants) from 26 countries. The incidence of any AKI was 26% (95% confidence interval: 22-29), and that of moderate-severe AKI was 14% (11-16). The incidence of AKI was similar in high-income 27% (23-32), low-middle-income 25% (13-38), and low-income 24% (12-39) countries. Overall, AKI-associated mortality was observed in 11% (9-13) of the pediatric population. AKI-associated mortality rate was highest at 18% (11-25) and 22% (9-38) in low-income and low-middle-income countries, respectively.

CONCLUSIONS

AKI was observed in one-quarter of the hospitalized children and is associated with increased mortality risk. Low-income and low-middle-income countries had observed higher mortality rates compared with high-income countries despite a similar AKI burden.

Low frequency of SARS-CoV2 infection in daycare centers during the reopening of school activities in the Southeast's poor area of Brazil

SARS-Cov2 has already infected over 482 million people and caused more than 6.1 million deaths. The beginning of the pandemic has led the health authorities of several countries to adopt non-pharmacological preventive measures such as daycare closures. The reopening took place when the country had the highest rates of infection and mortality (mainly due to the gamma variant (P.1) outbreak) and the beginning of the vaccination program. Therefore, we aimed to investigate the prevalence of SARS-CoV2 in daycare after educational activities resumed. The study was conducted in seven childcare facilities. Swab samples from the nasopharynx were collected from children and staff members. The viral RNA was obtained through PureLink RNA extraction kit purification and SARS-CoV2 presence was detected using the All plex SARS-CoV2 kit. The study population included 201 participants, including daycare workers and children. The average age of the workers and children is 40 and 3 years old, respectively. Among the children, 47.5% are female and among the workers, 91.4%. One (0.5%) test came out positive for the presence of SARS-CoV-2, which was from a sample of an asymptomatic childcare worker, and no secondary infections were detected. Considering that the return to daycare activities occurred during a period with a high number of deaths and a lack of vaccines throughout the country, the small number of cases indicates the effectiveness of the several preventive measures used by daycare centers in preventing SARS-CoV2 transmission.