Pediatric nephrology fellow UTHSC The University of Tennessee Health Science Center College of Medicine Memphis, Tennessee, United States
Background: Acute Kidney Injury (AKI) has been reported in patients with SARS-CoV2 infection. Early reports from China and Italy showed a wide range of incidence of AKI among adults with SARS-CoV2 infection ranging from 0.5% to 29%. There is limited data on kidney involvement in children with SARS-CoV2 and the risk factors associated with AKI in this population.
Objective: 1. Assess kidney involvement e.g., hematuria, proteinuria, and AKI in children with SARS-Cov2 infection 2. Examine the risk factors associated with AKI in the same group
Design/Methods: We have reviewed 94 charts of children admitted to Le Bonheur Children’s Hospital with SARS-CoV2 infection from April to November 2020. Children with any form of prior kidney disease were excluded. The cohort was divided into no AKI group (75 children) and AKI group (19 children). AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. All compared laboratory data were obtained at admission.
Results: The incidence of AKI among children admitted with SARS-CoV2 infection was 20%. Out of the 19 children with AKI, 57.9% had AKI stage I, 26.3% had AKI stage II and 15.7% had AKI stage III. None of the patients required any form of renal replacement therapy or kidney biopsy. 50% of children with AKI had hematuria and 50% had proteinuria on dipstick vs 22.7% and 9.3% among the no AKI group consecutively. Children with AKI were older (12 ± 4 vs 8±1.5 years, p=0.009) (Figure I), had lower serum albumin level (3.6±0.52 vs 4.1± 0.18, p=0.006) (FIgure II), lower platelet count (183 vs 327.6, p<0.0001) (FIgure III), but higher fibrinogen levels (369 vs 166 mg/dL, p=0.0156). Children with AKI were more likely to need invasive respiratory support than those with no AKI ( 56.3% vs 43.8%, p=0.0004) (Figure IV)). There was no difference between the 2 groups in sex, race, diabetes mellitus status, body mass index, serum sodium, hemoglobin level, and white blood cells count. Conclusion(s): Kidney involvement in children with SARS-CoV2 infection is not uncommon. Older age, lower serum albumin levels, lower platelet count, and higher fibrinogen levels at admission are associated with AKI in children with SARS-CoV2 infection. Obtaining these laboratory tests at admission can help identifying children at risk of developing AKI.
Figure: Age of enrolled patients
Figure II: Albumin level among studied groups
Figure III: Platelet count among studied groups
Figure IV: Invasive respiratory support among studied groups
Authors/Institutions: Xochitl A. Castillo, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States; Amal Ezzaiyani, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States; Arwa Nada, The University of Tennessee Health Science Center, Memphis, Tennessee, United States