AKI in COVID-19–Associated Multisystem Inflammatory Syndrome in Children (MIS-C)

Lipton, Marissa; Mahajan, Ruchi; Kavanagh, Catherine; Shen, Carol; Batal, Ibrahim; Dogra, Samriti; Jain, Namrata G.; Lin, Fangming; Uy, Natalie

doi:10.34067/kid.0005372020

Cited by 21 publications

(23 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Skin rash, which appeared in the early course of illness of our patient, is another cardinal sign of MIS-C. Our findings agree with previous findings that 36–81% of MIS-C patients had rash [ 45 , 47 , 55 – 61 ]. Laboratory findings of our case are in keeping with similar publications on leukopenia and thrombocytopenia [ 20 , 62 , 63 ] high ferritin, abnormal D-dimer, and elevated troponin [ 20 , 46 , 64 , 65 ]. In contrast to other findings, acute kidney injury (AKI) [ 64 , 66 – 69 ], prolonged coagulation profile, abnormal fibrinogen, and abnormal liver function[ 70 – 73 ] were not observed in our case.…”

Section: Discussionsupporting

confidence: 91%

An 11-Year-Old Saudi Arabian Girl Who Presented with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection with Coronary Artery Aneurysm and Cardiac Involvement: A Case Report

et al. 2021

View full text Add to dashboard Cite

Patient: Female, 11-year-old Final Diagnosis: Pediatrics multisystem inflammatory syndrome Symptoms: Cough • fever • shortness of breath Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Unusual clinical course Background: Early in the COVID-19 pandemic, children who were infected with severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) with vascular inflammation were described as having a vasculitis similar to Kawasaki’s disease. There are now consensus clinical guidelines that have described the presentation and diagnosis of multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection. This report aims to describe a case of MIS-C in an 11-year-old Saudi Arabian girl who presented with coronary artery aneurysm and cardiac involvement. Case Report: We describe an 11-year-old Saudi girl who was asymptomatic for 3 weeks after contracting SARS-CoV-2. Three weeks after suffering a mild flulike illness, she developed a high fever, cough, and severe clinical deterioration within 12 h of admission, including shock, rash, pleural effusion, high inflammatory markers, and a coronary aneurysm. As per current practice, the diagnosis was confirmed as multisystem inflammatory syndrome based on a SARS-CoV-2 test with reverse transcription polymerase chain reaction (RT-PCR) from 2 nasopharyngeal aspirates. Her condition was successfully treated with antibiotics, inotropes, IVIG, aspirin, and Tocilizumab, in addition to high-flow oxygen therapy. Eventually, she was able to return home after fully recovering. Conclusions: The findings in this report suggest that children with MIS-C due to SARS-CoV-2 infection can have a good prognosis, even when they suffer from coronary artery and cardiac involvement. The increasing number of emerging SARS-CoV-2 variants that affect children supports the importance of RT-PCR for the COVID-19 diagnostic test for children with multisystem or cardiovascular inflammation, which may guide the most appropriate clinical management of the variants of MIS-C.

show abstract

Section: Discussionsupporting

confidence: 91%

An 11-Year-Old Saudi Arabian Girl Who Presented with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection with Coronary Artery Aneurysm and Cardiac Involvement: A Case Report

et al. 2021

View full text Add to dashboard Cite

show abstract

“…This group found that renal involvement was associated with a greater elevation of CRP, ferritin, and procalcitonin, with greater lymphopenia and left ventricular dysfunction. It is suggested that the risk factors for acute kidney injury in children with MIS-C are greater age, greater inflammatory involvement, and ventricular dysfunction (28,30,31). In our study, we found high CRP and ferritin, indicative of a significant inflammatory response, along with frequent ventricular dysfunction,which might explain, in part, the frequency of AKI seen.…”

Section: Discussionsupporting

confidence: 56%

“…Although the pathophysiological mechanisms are unknown, we believe that in our study, delayed consultation, the lack of early recognition, the more significant inflammatory response, and frequent cardiovascular involvement, among others, may explain this greater frequency of kidney injury. Adults report 20% of kidney involvement in COVID-19, which may reach 50% in ICU patients, with a frequent need for continuous renal replacement therapy (28,29). In children with MIS-C, LiptonM et al ( 28) described 26 patients with acute kidney injury (AKI).…”

Section: Discussionmentioning

confidence: 99%

Mortality and Clinical Characteristics of Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 in critically ill patients: an observational multicenter study (MISCO STUDY)

Acevedo

Piñeres-Olave²,

Niño-Serna

et al. 2021

Preprint

View full text Add to dashboard Cite

Background The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 is widespread and presents a very low mortality rate in highincome countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries compared to described series in high-income countries along with the factors associated with mortality and worse outcomes. Methods An observational cohort study was conducted in 14 PICUs in Colombia between April 01, 2020 and January 31, 2021. Patient´s age ranged between one month and 18 years and they met the requirements set forth by WHO for MIS-C. Results There were seventy-eight children in this study. The median age was seven years (IQR 1- 11), 18% (14/78) were under one year old, and 56% were male. Thirty-five percent (29/78) were obese or overweight. The PICU stay was six days (IQR 4-7), and 100% had a fever on admission lasting five days (IQR 3.7-6). Seventy percent (55/78) had diarrhea, and 87% (68/78) had shock or myocardial dysfunction (78%). Compared to the United Kingdom (UK) study, there were more children under the age of five (37% vs. 10%; p=0.004), and there was a higher frequency of obesity (29.5% vs. 10%; p=0.008). With regard to the US study, there was more lymphadenopathy (23% vs. 13%; p=0.02), diarrhea (70.5% vs. 53%; p=0.001), lymphopenia (64% vs. 35%; p=0.001), shock (87% vs. 35%; p=0.001), elevated troponin (51% vs. 31%; p=0.006) and elevated proBNP (82% vs 43%; p=0.001), as well as greater mortality (9% vs 1.8%; p=0.001). The group that did not survive had a longer duration of the disease until admission to the PICU (6 days vs. 5 days; p = 0.003), more frequency of ferritin above 500 ngr/mL (100% vs. 45%; p = 0.012) and more cardiovascular complications (100% vs. 54%; p = 0.019) compared to the group that survived. Conclusions Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. It was observed inflammatory response, and cardiovascular involvement were conditions that, added to the difficulties in accessing healthcare systems in countries with limited resources, may explain the higher mortality seen in these children.

show abstract

“…A variable proportion (5–73%) of MIS-C patients have been found to have AKI ( 2 , 3 ). The pathophysiology of renal dysfunction in patients with SARS-CoV-2 infection is multifactorial including dehydration, poor cardiac output, cytokine storm, direct cytopathic effect of the virus on the renal tubular cells and use of nephrotoxic agents ( 5 ) whereas in patients presenting with MIS-C renal hypo-perfusion seems to be the major underlying factor for development of AKI ( 6 ). We conducted a retrospective chart review of pediatric patients with SARS-CoV-2 infection with or without MIS-C admitted to our hospital during the initial surge of the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

AKI in COVID-19–Associated Multisystem Inflammatory Syndrome in Children (MIS-C)

Cited by 21 publications

References 21 publications

An 11-Year-Old Saudi Arabian Girl Who Presented with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection with Coronary Artery Aneurysm and Cardiac Involvement: A Case Report

An 11-Year-Old Saudi Arabian Girl Who Presented with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection with Coronary Artery Aneurysm and Cardiac Involvement: A Case Report

Mortality and Clinical Characteristics of Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 in critically ill patients: an observational multicenter study (MISCO STUDY)

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

Contact Info

Product

Resources

About