Kidney Involvement in Pediatric COVID-19 Cases: A Single-Center Experience

Abstract

Objective: The kidney is the second most commonly affected organ by severe acute respiratory syndrome coronavirus-2, characterized by hematuria, proteinuria, and acute kidney injury. There are few studies describing renal involvement in pediatric cases. Materials and Methods: This retrospective study evaluated the prevalence of hematuria, proteinuria, and acute kidney injury in severe acute respiratory syndrome coronavirus-2-positive pediatric cases (1-18 years old) who visited emergency department between March and November 2020. Patients with urinary tract infections were excluded. An age-specific upper limit of reference interval was used to define “elevated serum creatinine” (greater than upper limit of reference interval) and acute kidney injury (>1.5 times upper limit of reference interval). Results: A total of 228 patients were evaluated, median age was 12.7 years (interquartile range: 7.5; 16.1), and 51.3% were male. The prevalence of asymptomatic, mild, and moderate-to-severe disease was 12.7% (29/228), 77.2% (176/228), and 10.1% (23/228), respectively. The prevalence of hematuria, proteinuria, and elevated serum creatinine was 15.8% (36/228), 6% (14/228), and 3% (7/228), respectively. Kidney involvement (i.e., at least 1 of these findings) was 23.2% (53/228) and significantly higher in the moderate-to-severe disease (43.5%). None of the patients met the acute kidney injury criterion. In logistic regression analysis, female sex (odds ratio: 1.97, 95 CI%: 1.03; 3.70, P = .040) and fever (odds ratio: 2.28, 95% CI: 1.19; 4.36, P = .012) were independent predictors of kidney involvement. Three patients demonstrated a kidney presentation (macroscopic hematuria) on admission, and another patient was diagnosed with C3 glomerulonephritis during hospitalization. Conclusion: Kidney involvement was found about in 1 quarter of children with coronavirus disease 2019. Awareness and recognition of kidney involvement and follow-up are important in the management.

Urine Parameters in Patients with COVID-19 Infection

“…The incidence of these two parameters was not as high as in the previously mentioned studies; however, it can predict adverse renal outcomes in long-term follow-up since Omicron infections may cause new kidney involvement [45]. for GLU [7,8,11]; for LEU (a) severe and critical COVID-19 [7,8,42], (b) COVID-19 AKI [25]; for KET [16]; for SG [4,5,10,16]; for BLOOD (a) severe and critical COVID-19 [7,8,10,11,29], (b) COVID-19 AKI [16,22,44], (c) COVID-19 mortality [14,16].…”

“…The studies presented by Yildirim, C. et al [ 9 ] and Bassoli, C et al [ 11 ] evaluated PRO as an early predictor of COVID-19-related renal damage [ 9 , 11 ]. The study of Baulos et al [ 42 ] and Sharma et al [ 31 ] confirmed that abnormal urinalysis results, such as PRO, haematuria, and LEU were higher in severe COVID-19 infection and also in patients who died of the disease [ 29 , 31 , 42 ]. Observations from patients affected with the Omicron COVID-19 infection in the post-acute treatment phase were reported.…”

“…In addition, the simultaneous increase in combined PRO and haematuria correlated with mortality in COVID-19 patients [12]. for GLU [7,8,11]; for LEU (a) severe and critical COVID-19 [7,8,42], (b) COVID-19 AKI [25]; for KET [16]; for SG [4,5,10,16]; for BLOOD (a) severe and critical COVID-19 [7,8,10,11,29], (b) COVID-19 AKI [16,22,44], (c) COVID-19 mortality [14,16].…”

“…Abbreviations: BLOOD, urine occult blood; PRO, proteinuria; GLU, glucose; LEU, leukocyturia; KET, ketones; SG, specific gravity; PH, potential of hydrogen. References: for PH [ 7 , 8 , 26 , 42 ]; for PRO (a) severe and critical COVID-19 [ 2 , 7 , 8 , 11 , 29 ], (b) COVID-19 AKI [ 25 ], (c) COVID-19 mortality [ 9 , 25 ]; for GLU [ 7 , 8 , 11 ]; for LEU (a) severe and critical COVID-19 [ 7 , 8 , 42 ], (b) COVID-19 AKI [ 25 ]; for KET [ 16 ]; for SG [ 4 , 5 , 10 , 16 ]; for BLOOD (a) severe and critical COVID-19 [ 7 , 8 , 10 , 11 , 29 ], (b) COVID-19 AKI [ 16 , 22 , 44 ], (c) COVID-19 mortality [ 14 , 16 ].…”