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Kidney Function Following COVID-19 in Children and Adolescents
Lu Li1,2, Ting Zhou1, Yiwen Lu1,2
1The Center for Health AI and Synthesis of Evidence, University of Pennsylvania, Philadelphia.
JAMA Network Open
|April 11, 2025
Summary
COVID-19 infection increases the risk of long-term kidney problems in children and adolescents. This risk is higher for those with existing kidney disease or acute kidney injury (AKI), highlighting the need for ongoing monitoring.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Public Health
Background:
- The long-term kidney health implications of SARS-CoV-2 infection in pediatric populations remain largely unknown.
- Understanding these risks is crucial for managing post-acute COVID-19 care in children and adolescents.
Purpose of the Study:
- To determine if SARS-CoV-2 infection is linked to an increased risk of kidney complications in children and adolescents.
- To assess these risks in subgroups with pre-existing kidney conditions or acute kidney injury (AKI).
Main Methods:
- A retrospective cohort study involving over 1.9 million pediatric patients from 19 US health institutions.
- Utilized data from the NIH RECOVER initiative (March 2020 - May 2023), comparing outcomes between SARS-CoV-2 positive and negative children.
- Kidney outcomes included new-onset chronic kidney disease (CKD) and composite kidney events, analyzed using Cox regression with propensity score stratification.
Main Results:
- SARS-CoV-2 infection was associated with a significantly higher risk of new-onset CKD stage 2+ (HR 1.17) and CKD stage 3+ (HR 1.35).
- In children with pre-existing CKD, COVID-19 increased the risk of composite kidney events (HR 1.15).
- Pediatric patients with acute-phase AKI showed elevated risks for composite kidney outcomes (HR 1.29) post-infection.
Conclusions:
- SARS-CoV-2 infection is associated with increased risks of adverse post-acute kidney outcomes in children and adolescents.
- The risk is particularly elevated for those with pre-existing kidney disease or prior AKI.
- Vigilant, long-term kidney monitoring is recommended for pediatric patients following SARS-CoV-2 infection.
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