tetano
Editor, Senior Moderator
Pediatr Nephrol
. 2020 Aug 26.
doi: 10.1007/s00467-020-04715-z. Online ahead of print.
Be aware of acute kidney injury in critically ill children with COVID-19
Xiaowen Wang[SUP] 1 [/SUP], Xingfeng Chen[SUP] 2 [/SUP], Feng Tang[SUP] 3 [/SUP], Wanjun Luo[SUP] 4 [/SUP], Jian Fang[SUP] 1 [/SUP], Chang Qi[SUP] 1 [/SUP], Hua Sun[SUP] 5 [/SUP], Han Xiao[SUP] 6 [/SUP], Xuehua Peng[SUP] 7 [/SUP], Jianbo Shao[SUP] 8 9 10 [/SUP]
Affiliations
Abstract
Background: Acute kidney injury (AKI) is a common complication of critically ill adult patients with COVID-19. However, currently, no studies investigate kidney impairment in children with COVID-19. We investigated incidence and treatment of AKI in pediatric patients with COVID-19 in Wuhan Children's Hospital during the early stages of the COVID-19 pandemic and discuss possible mechanisms of AKI related to SARS-CoV-2 infection.
Methods: By extracting data from electronic medical records, we conducted a retrospective observational study of kidney involvement in confirmed pediatric COVID-19 cases in Wuhan Children's Hospital during the coronavirus outbreak, from January 24 to March 20, 2020. Clinical presentations, clinical courses, laboratory findings, and medical interventions are described below.
Results: Among 238 confirmed COVID-19 cases, only three were critically ill and needed intensive care unit (ICU) admission. All three developed AKI, but AKI was not detected in any non-critically ill patients outside the ICU. Two of the three patients with AKI had prodromal gastrointestinal symptoms. Significantly elevated interleukin-6 (IL-6) levels and complement activation were observed in these patients with AKI. The three patients with AKI were treated with plasma exchange (PE) and continuous kidney replacement therapy (CKRT), resulting in one complete recovery, one partial recovery, and one mortality due to critical illness.
Conclusions: Critically ill children with COVID-19 may develop AKI, especially following prodromal gastrointestinal symptoms. An inflammatory storm and complement-mediated injury may underlie AKI development in children with COVID-19. Our study supports implantation of PE and CKRT in management of critically ill patients with AKI.
Keywords: AKI; CKRT; COVID-19; Plasmapheresis.
. 2020 Aug 26.
doi: 10.1007/s00467-020-04715-z. Online ahead of print.
Be aware of acute kidney injury in critically ill children with COVID-19
Xiaowen Wang[SUP] 1 [/SUP], Xingfeng Chen[SUP] 2 [/SUP], Feng Tang[SUP] 3 [/SUP], Wanjun Luo[SUP] 4 [/SUP], Jian Fang[SUP] 1 [/SUP], Chang Qi[SUP] 1 [/SUP], Hua Sun[SUP] 5 [/SUP], Han Xiao[SUP] 6 [/SUP], Xuehua Peng[SUP] 7 [/SUP], Jianbo Shao[SUP] 8 9 10 [/SUP]
Affiliations
- PMID: 32844290
- DOI: 10.1007/s00467-020-04715-z
Abstract
Background: Acute kidney injury (AKI) is a common complication of critically ill adult patients with COVID-19. However, currently, no studies investigate kidney impairment in children with COVID-19. We investigated incidence and treatment of AKI in pediatric patients with COVID-19 in Wuhan Children's Hospital during the early stages of the COVID-19 pandemic and discuss possible mechanisms of AKI related to SARS-CoV-2 infection.
Methods: By extracting data from electronic medical records, we conducted a retrospective observational study of kidney involvement in confirmed pediatric COVID-19 cases in Wuhan Children's Hospital during the coronavirus outbreak, from January 24 to March 20, 2020. Clinical presentations, clinical courses, laboratory findings, and medical interventions are described below.
Results: Among 238 confirmed COVID-19 cases, only three were critically ill and needed intensive care unit (ICU) admission. All three developed AKI, but AKI was not detected in any non-critically ill patients outside the ICU. Two of the three patients with AKI had prodromal gastrointestinal symptoms. Significantly elevated interleukin-6 (IL-6) levels and complement activation were observed in these patients with AKI. The three patients with AKI were treated with plasma exchange (PE) and continuous kidney replacement therapy (CKRT), resulting in one complete recovery, one partial recovery, and one mortality due to critical illness.
Conclusions: Critically ill children with COVID-19 may develop AKI, especially following prodromal gastrointestinal symptoms. An inflammatory storm and complement-mediated injury may underlie AKI development in children with COVID-19. Our study supports implantation of PE and CKRT in management of critically ill patients with AKI.
Keywords: AKI; CKRT; COVID-19; Plasmapheresis.