Acute kidney injury in pediatric patients hospitalized with acute COVID-19 and multisystem inflammatory syndrome in children associated with COVID-19

Basalely, Abby; Gurusinghe, Shari; Schneider, James; Shah, Sareen; Siegel, Louis; Pollack, Gabrielle; Singer, Pamela; Castellanos-Reyes, Laura; Fishbane, Steven; Jhaveri, Kenar D.; Mitchell, Elizabeth; Merchant, Kumail; Capone, Christine A.; Gefen, Ashley M.; Steinberg, Julie; Sethna, Christine B.

doi:10.1016/j.kint.2021.02.026

Cited by 57 publications

(91 citation statements)

References 31 publications

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“…Scarce histological data are available, showing in most cases ATN, collapsing glomerulopathy or TMA in patients with acute COVID-19 infection ( 18 – 22 ). AKI is also common during MIS-C, ranging from 10% to 60% of the cases ( 6 , 23 , 24 ) while it was described in four adults in a case series of 20 MIS-A with cardiac involvement ( 12 ). Currently, the pathogenesis of AKI in MIS is thought to be mainly related to cytokine-mediated hypotension and cardiac dysfunction, leading to renal hypoperfusion ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

“…There is growing evidence that COVID-19 affects the endothelial system, leading to endothelial dysfunction characterised by a pro-inflammatory and procoagulative state (2)(3)(4)(5). Clinical series of Kawasaki-like multisystem inflammatory syndrome (MIS), occurring after viral clearance, have been described in children (MIS-C) (6)(7)(8)(9). Recently, similar case Abbreviations: aHUS, atypical haemolytic uremic syndrome; AKI, acute kidney injury; BMI, body mass index; CFB, Complement factor B; CFH, Complement factor H; CFI, Complement factor I; MCP, Membrane Cofactor Protein; CRP, C-reactive protein; hsTroponin, high-sensitivity troponin; MAC, membrane attack complex; MIS-C, multisystem inflammatory syndrome in children; MIS-A, multisystem inflammatory syndrome in adults; PCR, polymerase chain reaction; RRT, renal replacement therapy; sCr, serum creatinine; sC5b-9, soluble C5b-9; TMA, thrombotic microangiopathy; THBD, Thrombomodulin.…”

Section: Introductionmentioning

confidence: 99%

“…There is growing evidence that COVID-19 affects the endothelial system, leading to endothelial dysfunction characterised by a pro-inflammatory and pro-coagulative state ( 2 – 5 ). Clinical series of Kawasaki-like multisystem inflammatory syndrome (MIS), occurring after viral clearance, have been described in children (MIS-C) ( 6 – 9 ). Recently, similar case series of MIS were described in adults (MIS-A) ( 10 – 15 ).…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Adult Post-COVID-19 Multisystem Inflammatory Syndrome and Thrombotic Microangiopathy

et al. 2021

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BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide. A clinical series of Kawasaki-like multisystem inflammatory syndrome (MIS), occurring after SARS-CoV-2 infection, have been described in children (MIS-C) and adults (MIS-A), but the pathophysiology remains unknown.Case PresentationWe describe a case of post-COVID-19 MIS-A in a 46-year-old man with biopsy-proven renal thrombotic microangiopathy (TMA). Specific complement inhibition with eculizumab was initiated promptly and led to a dramatic improvement of renal function.ConclusionOur case suggests that that TMA could play a central role in the pathophysiology of post-COVID-19 MIS-A, making complement blockers an interesting therapeutic option.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Case Report: Adult Post-COVID-19 Multisystem Inflammatory Syndrome and Thrombotic Microangiopathy

et al. 2021

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“…AKI developed at admission in most of them which were associated with lower serum albumin levels and higher white blood cell counts. 47 Two out of 9 MIS-C patients recently reported from Germany had unusual findings. One developed encephalomyelitis.…”

Section: Clinical Featuresmentioning

confidence: 95%

A Novel and Severe Clinical Picture Related to COVID-19: Multi-Inflammatory Syndrome in Children

Haşlak¹,

Yi̇ldi̇z²,

Şahin³

et al. 2021

Trends in Pediatrics

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Preliminary data have suggested that children have milder COVID-19 disease course compared to adults. However, pediatric cases with severe clinical findings caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) are being reported since April 2020. These children have been presented with significant hyperinflammatory states resembling Kawasaki disease, toxic shock syndrome, and macrophage activation syndrome. However, they had several distinct features, as well. Therefore, this novel condition was considered a unique disease and named Multi-inflammatory syndrome in children (MIS-C). Thus, new concerns have been raised regarding the vulnerability of the children. However, it has been realized that this condition is extremely rare. Nonetheless, considering that it is a life-threatening disease and may cause devastating consequences, clinicians should be aware of MIS-C while evaluating children with persistent fever and history of COVID-19 contact or active infection.

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“…In this issue of Kidney International, Basalely et al do just that by providing additional data on the incidence, clinical characteristics, and outcomes of COVID-19 in a cohort of 152 children (aged <18 years) who were admitted to 4 New York hospitals during the height of the COVID-19 pandemic. 5 AKI developed in 11.8% (18 patients) of this cohort (combined acute COVID-19 and multisystem inflammatory syndrome in children [MIS-C]) and completely resolved in 83% of them. These findings are in contrast to a crosssectional point prevalence study of AKI in COVID-19 patients that reported the development of AKI in nearly half (44%) of 106 children admitted to ICUs in 41 centers, 32 of which were United States based.…”

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confidence: 99%

COVID-19 and the multisystem inflammatory syndrome in children: how vulnerable are the kidneys?

Chadha

Warady

2021

Kidney International

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Yu et al. reported that the PHD inhibitor L-mimosine exerted dual action on CKD progression in a rat model of subtotal nephrectomy. Midterm administration of L-mimosine inhibited renal fibrosis, and macrophage infiltration and CKD progression; however, the long-term administration of L-mimosine worsened all these parameters. 7 Therefore, the protective effect of HIF activation against CKD progression might depend on the timing of HIF-PHI administration. In contrast, a recent study reported that in patients with CKD at stage 3 to 5 receiving either roxadustat or placebo, there was no significant between-group difference in progression of CKD, as measured by the rate of change in estimated glomerular filtration rate over time. 8 FGF23 is mainly produced in osteocytes to regulate phosphate homeostasis. Plasma levels of FGF23 are elevated in patients with CKD, which is an independent risk factor for endstage renal disease and cardiovascular mortality. HIF activation, as well as EPO and iron deficiency, can increase FGF23 mRNA transcription with increased posttranscriptional cleavage. 9 Vadadustat increased plasma total and intact FGF23 levels in non-CKD mice. In contrast, in CKD mice, vadadustat diminished the elevated plasma levels of total and intact FGF23, which is inconsistent with previous findings. According to the authors, vadadustat reduced plasma FGF23 levels in the CKD model owing to the amelioration of kidney function and impaired iron utilization. However, the mechanism by which HIF-PHIs affect FGF23 regulation in CKD still needs to be clarified.Overall, the study by Hanudel et al. provides new information on the effects of HIF-PHIs in improving the anemia of CKD, which could be useful in current clinical practice. Furthermore, despite its experimental nature, the study provides future directions for research on the action of HIF-PHIs in patients with CKD (Figure 1).

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Acute kidney injury in pediatric patients hospitalized with acute COVID-19 and multisystem inflammatory syndrome in children associated with COVID-19

Cited by 57 publications

References 31 publications

Case Report: Adult Post-COVID-19 Multisystem Inflammatory Syndrome and Thrombotic Microangiopathy

Case Report: Adult Post-COVID-19 Multisystem Inflammatory Syndrome and Thrombotic Microangiopathy

A Novel and Severe Clinical Picture Related to COVID-19: Multi-Inflammatory Syndrome in Children

COVID-19 and the multisystem inflammatory syndrome in children: how vulnerable are the kidneys?

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