Acute Kidney Injury in Pediatric Acute SARS-CoV-2 Infection and Multisystem Inflammatory Syndrome in Children...

Area of Science:

• Pediatric Nephrology
• Infectious Diseases
• Critical Care Medicine

Background:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to significant morbidity in children.
• Multisystem inflammatory syndrome in children (MIS-C) is a serious complication associated with SARS-CoV-2.
• Acute kidney injury (AKI) is a potential complication in critically ill children, but its prevalence in SARS-CoV-2 and MIS-C requires further investigation.

Purpose of the Study:

• To determine the incidence of AKI in pediatric patients diagnosed with SARS-CoV-2 infection, with or without MIS-C.
• To identify clinical and laboratory factors associated with the development of AKI in this patient population.
• To understand the distinct pathophysiological mechanisms of AKI in SARS-CoV-2 infection versus MIS-C.

Main Methods:

• Retrospective chart review of 113 pediatric patients admitted with SARS-CoV-2 infection between March and August 2020.
• Data collection included demographics, laboratory results, imaging, echocardiography, and treatment details.
• Statistical analysis, including multivariate analysis, was performed to identify predictors of AKI.

Main Results:

• Of 92 analyzed patients, 24% developed AKI, with 36% of those reaching stage 3 AKI.
• AKI prevalence was significantly higher in patients with MIS-C (54%) compared to those with acute SARS-CoV-2 infection (11%).
• Independent predictors for AKI included inotropic support, African American race, and MIS-C diagnosis. All patients recovered kidney function without requiring renal replacement therapy.

Conclusions:

• Pediatric patients with SARS-CoV-2 infection, particularly those with MIS-C, are at substantial risk for developing AKI.
• AKI in SARS-CoV-2 appears multifactorial, involving renal hypoperfusion and direct damage, while MIS-C related AKI is primarily pre-renal due to cardiac dysfunction and hyperinflammation.
• Clinicians should prioritize renal protective strategies for high-risk pediatric patients with SARS-CoV-2 and MIS-C to ensure optimal kidney recovery and prevent further injury.