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COVID-19 in children treated with immunosuppressive medication for kidney diseases
Matko Marlais1,2, Tanja Wlodkowski3, Samhar Al-Akash4
1UCL Great Ormond Street Institute of Child Health, University College London, London, UK m.marlais@ucl.ac.uk.
Insights
Children with kidney disease on immunosuppressants generally experience mild COVID-19. This study suggests these children do not require stricter isolation than others, even with SARS-CoV-2 infection.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Immunology
Background:
- Children typically face lower severe COVID-19 risk than adults.
- The impact of immunosuppression on pediatric COVID-19 severity was previously undetermined.
Purpose of the Study:
- To describe the clinical course of COVID-19 in pediatric kidney disease patients on immunosuppressive medication.
- To assess the severity of COVID-19 in this vulnerable population.
Main Methods:
- A cross-sectional study involving 113 children (<20 years) with kidney conditions on immunosuppressants.
- Data collected globally via online submission through the European Rare Kidney Disease Reference Network.
- Primary outcome measured was the severity of COVID-19 illness.
Main Results:
- Most children (78%) did not require respiratory support; 5% needed advanced support.
- Four deaths occurred, all in low-income countries with comorbidities.
- No significant differences in COVID-19 severity were observed based on gender, dialysis status, kidney condition, or immunosuppressive regimen.
Conclusions:
- Most children with kidney disease on immunosuppressive therapy experience mild SARS-CoV-2 infection.
- Stricter isolation for these children is not recommended compared to non-immunosuppressed peers.
Background:
Children are recognised as at lower risk of severe COVID-19 compared with adults, but the impact of immunosuppression is yet to be determined. This study aims to describe the clinical course of COVID-19 in children with kidney disease taking immunosuppressive medication and to assess disease severity.
Methods:
Cross-sectional study hosted by the European Rare Kidney Disease Reference Network and supported by the European, Asian and International paediatric nephrology societies. Anonymised data were submitted online for any child (age <20 years) with COVID-19 taking immunosuppressive medication for a kidney condition. Study recruited for 16 weeks from 15 March 2020 to 05 July 2020. The primary outcome was severity of COVID-19.
Results:
113 children were reported in this study from 30 different countries. Median age: 13 years (49% male). Main underlying reasons for immunosuppressive therapy: kidney transplant (47%), nephrotic syndrome (27%), systemic lupus erythematosus (10%). Immunosuppressive medications used include: glucocorticoids (76%), mycophenolate mofetil (MMF) (54%), tacrolimus/ciclosporine A (58%), rituximab/ofatumumab (11%). 78% required no respiratory support during COVID-19 illness, 5% required bi-level positive airway pressure or ventilation. Four children died; all deaths reported were from low-income countries with associated comorbidities. There was no significant difference in severity of COVID-19 based on gender, dialysis status, underlying kidney condition, and type or number of immunosuppressive medications.
Conclusions:
This global study shows most children with a kidney disease taking immunosuppressive medication have mild disease with SARS-CoV-2 infection. We therefore suggest that children on immunosuppressive therapy should not be more strictly isolated than children who are not on immunosuppressive therapy.
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