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Published on: November 7, 2020
Renal manifestations of COVID 19 in children
Aliza Mittal1, Pallavi Nadig1, Kuldeep Singh1
1Department of Pediatrics, AIIMS, Jodhpur, Rajasthan, India.
Insights
COVID-19 can cause kidney problems in children, with acute kidney injury (AKI) being common. Management of pediatric AKI in COVID-19 follows standard principles, regardless of prior immunosuppression.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) significantly impacts hospitalized patients.
- COVID-19 presents with diverse renal manifestations in children, distinct from its pulmonary effects.
- Understanding pediatric renal complications of SARS-CoV-2 is crucial.
Purpose of the Study:
- To review the renal manifestations and complications of COVID-19 in children.
- To synthesize current evidence on pediatric kidney involvement during the pandemic.
Main Methods:
- Systematic literature search using PubMed/Medline, Embase, and Google Scholar.
- Keywords included AKI, renal failure, kidney disease, children, pediatric, COVID-19, and SARS-CoV-2.
- Patient intervention control outcome model applied for data collection and study selection.
Main Results:
- Renal involvement in COVID-19 occurs in 10-15% of pediatric cases, exceeding SARS rates.
- Acute kidney injury is the most frequent renal manifestation in pediatric intensive care units.
- Other reported renal issues include proteinuria, hematuria, rhabdomyolysis, and thrombotic microangiopathy.
Conclusions:
- COVID-19 leads to varied renal manifestations in children through direct and indirect mechanisms.
- Children with pre-existing immunosuppression do not appear to experience more severe COVID-19 illness.
- Management of AKI in pediatric COVID-19 patients aligns with general AKI treatment protocols.
Abstract:
Acute kidney injury (AKI) is an important factor affecting the outcome of hospitalized patients under any disease condition. While a lot has been said and studied about pulmonary manifestations of COVID-19 and multisystem inflammatory syndrome in children, this review focuses on its renal manifestations in children with and its complications. For the collection of data, the patient intervention control outcome model was applied to determine all eligible studies. The data was extracted using PubMed/Medline, Embase, and Google Scholar databases using a combination of keywords (AKI, renal failure, kidney disease, children, pediatric, covid-19, SARS COv2). Studies were reviewed after the exclusion of duplicates. The incidence of renal involvement in COVID 19 is up to 10-15%, which is higher than SARS. Both direct and indirect pathogenic mechanisms operate in patients with COVID 19 leading to varied manifestations. While AKI remains the most common manifestation in children admitted to intensive care units, other manifestations like, proteinuria, hematuria, rhabdomyolysis, and thrombotic microangiopathy have also been described in the literature. The children already on immunosuppression due to transplant or immune-mediated renal disorders do not seem to have more severe illness than those without it. The principles of management of AKI in COVID have not been different than other patient groups.
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