Acute Kidney Injury in Pediatric Acute SARS-CoV-2 Infection and Multisystem Inflammatory Syndrome in Children (MIS-C): Is There a Difference?

Abstract

Objective: To evaluate the prevalence and factors associated with the risk of acute kidney injury (AKI) in pediatric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem inflammatory syndrome in children (MIS-C).Study Design: We performed a retrospective chart review of 113 patients with SARS-CoV-2 infection with or without MIS-C admitted at Children's Hospital of Michigan (CHM) from March to August 2020. Patient demographic details, laboratory data, imaging studies, echocardiography reports, and treatment data were collected.Results: Of the 92 patients included in the final analysis, 22 (24%) developed AKI with 8/22 (36%) developing stage 3 AKI. The prevalence of AKI was much higher in patients with MIS-C 15/28 (54%) vs. those with acute SARS-CoV-2 infection 7/64 (11%), (p < 0.001). Overall, when compared to patients without AKI, patients with AKI were older in age (11 vs. 6.5 years, p = 0.007), African American (86 vs. 58%, p = 0.028), had MIS-C diagnosis (68 vs. 19%, p < 0.001), required ICU admission (91 vs. 20%, p < 0.001), had cardiac dysfunction (63 vs. 16%, p < 0.001), required inotropic support (59 vs. 6%, p < 0.001) and had a greater elevation in inflammatory markers. In a multivariate analysis, requirement of inotropes [Odds Ratio (OR)−22.8, p < 0.001], African American race (OR-8.8, p = 0.023) and MIS-C diagnosis (OR-5.3, p = 0.013) were the most significant predictors for AKI. All patients had recovery of kidney function, and none required kidney replacement therapy.Conclusion: Children with acute SARS-CoV-2 infection and MIS-C are at risk for AKI, with the risk being significantly greater with MIS-C. The pathogenesis of AKI in acute SARS-CoV-2 infection appears to be a combination of both renal hypo-perfusion and direct renal parenchymal damage whereas in MIS-C, the renal injury appears to be predominantly pre-renal from cardiac dysfunction and capillary leak from a hyperinflammatory state. These factors should be considered by clinicians caring for these children with a special focus on renal protective strategies to aid in recovery and prevent additional injury to this high-risk subgroup.

Neurological complications of COVID-19 in pediatric patients require comprehensive evaluation

“…We do not agree with the notion that COVID-19 in pediatric patients usually takes a mild course (Krueger et al 2021). There are several reports about paediatric patients with severe COVID-19 or its complications (O'Loughlin et al 2021;Grewal et al 2021).…”

Hematuria as an Early Sign of Multisystem Inflammatory Syndrome in Children: A Case Report of a Boy With Multiple Comorbidities and Review of Literature

“…Additionally, among 277 MIS-C patients with renal involvement identified during our literature search, the most commonly reported manifestation was AKI ( Table 1 ). Compared to patients without AKI, it was more frequent among patients who had cardiac dysfunction, required inotropic support, and ICU admission ( 26 ). Accordingly, pathogenesis of AKI appears to be predominantly pre-renal ( 26 ).…”

“…Compared to patients without AKI, it was more frequent among patients who had cardiac dysfunction, required inotropic support, and ICU admission ( 26 ). Accordingly, pathogenesis of AKI appears to be predominantly pre-renal ( 26 ). On the other hand, severity of kidney dysfunction in patients with AKI did not correlate with degree of cardiac dysfunction ( 26 ).…”

“…Accordingly, pathogenesis of AKI appears to be predominantly pre-renal ( 26 ). On the other hand, severity of kidney dysfunction in patients with AKI did not correlate with degree of cardiac dysfunction ( 26 ). Beside AKI, other renal manifestations or urinalysis results in MIS-C patients were described only in few articles, reporting variable degrees of hematuria, proteinuria, and pyuria ( 21 , 24 , 28 ).…”

Commentary: Hematuria as an early sign of multisystem inflammatory syndrome in children: A case report of a boy with multiple comorbidities and a review of the literature

“…The authors perhaps hastily concluded that hematuria is an early sign of MIS-C, especially in a patient with no apparent acute kidney injury (normal creatinine level). Nor is this the first published case of MIS-C-related hematuria at the time of the article's release ( 16 , 31 ). Therefore, the content of the article does not correspond with the title of the article.…”