COVID-19 in Children with Nephrotic Syndrome on Anti-CD20 Chronic Immunosuppression

Angeletti, Andrea; Drovandi, Stefania; Sanguineri, Francesca; Santaniello, Maria Grazia; Ferrando, Giulia; Forno, Roberto; Cipresso, Gaia; Caridi, Gianluca; Riella, Leonardo V.; Cravedi, Paolo; Ghiggeri, Gian Marco

doi:10.2215/cjn.06400420

Cited by 32 publications

(31 citation statements)

References 5 publications

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“…Both patients' immune responses may have been further impaired due to immunosuppressive medications (colchicine and mycophenolate mofetil in the first, eculuzimab and chronic prednisone in the second). This mild course is similar to other reports of children on chronic immunosuppressive therapy including immunomodulators and biologic therapies 12,13 . We speculate that immunosuppression may be at least in part responsible for the mild disease course observed in these patients; however, we acknowledge that this may also simply reflect the overall more mild course generally seen in children.…”

Section: Discussionsupporting

confidence: 88%

“…This mild course is similar to other reports of children on chronic immunosuppressive therapy including immunomodulators and biologic therapies. 12,13 We speculate that immunosuppression may be at least in part responsible for the mild disease course observed in these patients; however, we acknowledge that this may also simply reflect the overall more mild course generally seen in children. We also note the prolonged viral shedding in patient 1 (21 days), which has been reported in other case…”

Section: Discussionmentioning

confidence: 90%

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Coronavirus disease 2019 (COVID‐19) in two pediatric patients with kidney disease on chronic immunosuppression: A case series

Rawson

Wilson

Schwaderer

et al. 2020

Hemodialysis International

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Coronavirus disease 2019 (COVID‐19) is a highly infectious disease caused by the severe acute respiratory syndrome coronavirus 2 virus (SARS‐CoV‐2). While children appear to experience less severe disease than adults, those with underlying conditions such as kidney disease may be more susceptible to infection. Limited data are present for children with kidney disease, and there are limited prior reports of pediatric hemodialysis patients with COVID‐19. This report describes the mild clinical disease course of COVID‐19 in two pediatric patients with chronic kidney disease, one on hemodialysis and both on chronic immunosuppression. We review treatment in these patients, as well as our measures to reduce transmission among our hemodialysis patients and staff.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 90%

Coronavirus disease 2019 (COVID‐19) in two pediatric patients with kidney disease on chronic immunosuppression: A case series

Rawson

Wilson

Schwaderer

et al. 2020

Hemodialysis International

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“…A case series of pemphigus vulgaris patients on rituximab demonstrated that only 5/147 patients developed COVID-19, with none requiring hospitalization [16]. An Italian survey of 159 pediatric patients with relapsing nephrotic syndrome treated with anti-CD20 antibodies identified no cases of COVID-19 infection [17]. Severe respiratory presentations of COVID-19 have been reported immediately post rituximab therapy in patients with rheumatic disease [18,19], albeit one of the reports does hypothesize that rituximab may have limited the cytokine storm and delayed worsening of clinical status of a patient with AAV [19].…”

Section: Discussionmentioning

confidence: 99%

The impact of COVID-19 pandemic on patients with ANCA associated vasculitis

et al. 2020

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Introduction The coronavirus 2019 (COVID-19) pandemic has brought on challenges not only to acute care, but also chronic care of patients. Individuals maintained on immunosuppression appear to be especially susceptible to COVID-19 infection. Patients with ANCA-associated vasculitis (AAV) frequently require immunosuppression and may be at increased risk for developing COVID-19. The incidence and impact of COVID-19 on patients with AAV is currently not known. We aimed to investigate this impact via a telephone questionnaire-based patient survey and chart review. Methods A cross-sectional study of AAV patients followed at two centers was conducted. Data regarding demographics, disease characteristics and therapy were confirmed by chart review. A telephone survey was conducted to ascertain symptoms and contact exposure related to COVID-19, as well as changes in health care delivery during the pandemic period between January and July, 2020. Results Of the 206 patients surveyed, the median age was 64 years, 51% were female and mean (SD) disease duration was 7 (5) years. The majority had kidney (n = 160) and lung (n = 108) involvement. Seventy-five percent (n = 155) were receiving immunosuppression, with 77 patients (50%) receiving rituximab during the pandemic period. Of the 10 patients tested for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) by PCR, three were positive. Patients had a significant disruption in care; none had an in-person visit and 69% had a telemedicine consultation. Rituximab maintenance was postponed in 21 patients. Twelve patients experienced disease relapse. Conclusion The incidence of COVID-19 in patients with AAV appears to be similar to that of the general population. For a patient population that requires active clinical surveillance, there is significant disruption in care as a result of the pandemic. Reduction of immunosuppression may not be indicated, and the risk of relapse likely far outweighs the risk of COVID-19.

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“…Nonetheless, there are no published data regarding the outcomes of COVID-19 in adult patients with underlying glomerular diseases. 10 , 11 Although this is a heterogeneous group of patients spanning a wide age range and encompassing diverse disease mechanisms, it is reasonable to believe that these patients may represent a particularly vulnerable group with a heightened risk of severe disease manifestations due to an interplay of factors related to the immunosuppressive medications, underlying immune dysfunction, and comorbidities.…”

mentioning

confidence: 99%

Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring

Waldman

Soler

García-Carro

et al. 2021

Kidney International

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The effects of SARS-CoV-2 infection on individuals with immune-mediated glomerulonephritis, who are often undergoing immunosuppressive treatments, are unknown. Therefore, we created the International Registry of COVID infection in glomerulonephritis (IRoc-GN) and identified 40 patients with glomerulonephritis and COVID-19 followed in centers in North America and Europe. Detailed information on glomerulonephritis diagnosis, kidney parameters, and baseline immunosuppression prior to infection were recorded, as well as clinical presentation, laboratory values, treatment, complications, and outcomes of COVID-19. This cohort was compared to 80 COVID-positive control cases from the general population without glomerulonephritis matched for the time of infection. The majority (70%) of the patients with glomerulonephritis and all the controls were hospitalized. Patients with glomerulonephritis had significantly higher mortality (15% vs. 5%, respectively) and acute kidney injury (39% vs. 14%) than controls, while the need for kidney replacement therapy was not statistically different between the two groups. Receiving immunosuppression or renin-angiotensin-aldosterone system inhibitors at presentation did not increase the risk of death or acute kidney injury in the glomerulonephritis cohort. In the cohort with glomerulonephritis, lower serum albumin at presentation and shorter duration of glomerular disease were associated with greater risk of acute kidney injury and need for kidney replacement therapy. No differences in outcomes occurred between patients with primary glomerulonephritis versus glomerulonephritis associated with a systemic autoimmune disease (lupus or vasculitis). Thus, due to the higher mortality and risk of acute kidney injury than in the general population without glomerulonephritis, patients with glomerulonephritis and COVID-19 should be carefully monitored, especially when they present with low serum albumin levels.

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COVID-19 in Children with Nephrotic Syndrome on Anti-CD20 Chronic Immunosuppression

Cited by 32 publications

References 5 publications

Coronavirus disease 2019 (COVID‐19) in two pediatric patients with kidney disease on chronic immunosuppression: A case series

Coronavirus disease 2019 (COVID‐19) in two pediatric patients with kidney disease on chronic immunosuppression: A case series

The impact of COVID-19 pandemic on patients with ANCA associated vasculitis

Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring

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