Kidney involvement in multisystem inflammatory syndrome in children: a pediatric nephrologist’s perspective

Abstract

The initial report of the multisystem inflammatory syndrome (MIS-C) in children was from the United Kingdom in April 2020; since then, cases have been reported worldwide. Renal involvement has been seen commonly, ranging from 10% to 46%. Kidney involvement following SARS-CoV-2 infection in children with MIS-C is more common than initially thought and is associated with higher morbidity and mortality. There are several reports of a direct viral tropism of COVID-19 and MIS-C associated renal damage. This study's objective was to systematically review the current understanding of kidney involvement in children suffering from MIS-C. Based on our systemic literature search, 19 studies have either partially or fully discussed kidney involvement in MIS-C patients. Furthermore, we discuss the multifactorial pathogenesis contributing to AKI development in MIS-C. Conclusion: The current review gives a Pediatric Nephrologist's perspective of the renal involvement in MIS-C, the incidence of Acute Kidney Injury (AKI), the pathophysiology of AKI in MIS-C, and the proposed therapeutic regimens available, including the need for Kidney replacement therapy for a child with AKI associated with MIS-C. As the disease is rapidly evolving, more detailed clinical prospective studies are required to understand MIS-C and its role in AKI better.

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

“…The European Renal Association revealed that advanced chronic kidney disease is an independent risk factor for poorer outcome of COVID-19 (45), while de novo kidney disease is commonly seen in hospitalized patients with COVID-19 as well, especially in those critically ill (46). The available literature most commonly describes renal involvement in children with MIS-C as acute renal failure or AKI (4,39,(47)(48)(49)(50). The prevalence of renal involvement varies greatly depending on the studied population (4,39,(47)(48)(49).…”

Post COVID-19 hyperinflammatory acute kidney injury and background ovarian insufficiency: Renal functional restoration after combined angiotensin-converting enzyme inhibitor with estrogen replacement

“…The hyperin ammatory renal presentation of MIS-C is congruent with features of Kawasaki disease and toxic shock syndrome [21][22][23], particularly high fever and severe multisystem involvement (e.g., cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic, or neurologic) [24]. CDC national surveillance data on COVID-19 patients age ≤ 24yrs nd only 2.5% of this group require hospitalization, and fewer still (0.8%) need ICU support [25].…”

Clinical presentation and short-term outcomes of multisystemic inflammatory syndrome in children in Lagos, Nigeria during the COVID-19 pandemic: A case series

“… 34 Renal involvement has been reported in 10% to 60% of MIS-C patients across studies and in keeping with this, one third of patients in this cohort had abnormalities of renal function. 35 …”