Prevalence of SARS-CoV-2-IgG Antibodies in Children with CKD or Immunosuppression

Background Coronavirus Disease 2019 has spread from China as a global pandemic, Italy being one of the earliest affected countries. The infection displays a more complicated and often fatal course in adults with a history of kidney disease, while it does not seem to affect children in the same way. Pediatric patients with idiopathic nephrotic syndrome (INS), with or without chronic immunosuppressive therapy, are at greater risk of infections which may also trigger relapses. Objectives We performed a systematic review of the literature to identify all articles on SARS-CoV-2 infections in children with INS in order to describe the severity of all SARS-CoV-2 infections reported in children with INS, to evaluate the risk of new onset and relapses associated with SARS-CoV-2 infection, and to draw recommendations on their management and vaccination. The search was conducted on the following databases: MEDLINE (via Pubmed), Google Scholar, and Web of Science. The search methodology used with the selected free text terms or MesH was (“nephrotic syndrome” OR “idiopathic nephrotic syndrome”) and (“covid 19” OR "severe acute respiratory syndrome coronavirus 2" OR "2019-nCoV" OR "SARS-CoV-2"). Results The literature search provided 36 records. After screening for their relevance to the topic, 11 studies were selected. Two additional publications were identified through the reference list of all included articles and 13 articles were included in the review. A total of 43 cases of children with INS and SARS-CoV-2 infection have been reported; the course of the disease was mild for most patients with low need of respiratory support and no death in high income countries. In 5 patients, the infection was complicated by relapse, which anyway showed a good response to steroids. Two children had a new onset of INS during a SARS-CoV-2 infection. Conclusions Children with INS, with or without immunosuppression, are not at higher risk of severe SARS-CoV-2 infection. Relapse is a possible complication, but steroid treatment is safe and effective. After summarizing the evidence, we have suggested recommendations for the management of children with INS during the pandemic and the vaccination campaign. Graphical abstract

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“…To date, only 3 studies, all performed in Italy, have addressed the diffusion of SARS-CoV-2 among children with INS [ 5 , 9 , 10 ].…”

Section: Resultsmentioning

confidence: 99%

“…After the first wave, a seroprevalence study was performed on the same population by the ISPN [ 9 ]. 178 randomly selected patients together with their family members, and 161 children with a history of symptoms suggestive for a viral infection, included in the previous study [ 5 ], were tested.…”

Section: Resultsmentioning

confidence: 99%

COVID-19 and idiopathic nephrotic syndrome in children: systematic review of the literature and recommendations from a highly affected area

et al. 2021

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“…SARS-COV-2 infection usually runs asymptomatic both in previously healthy and nephropatic children [1,[3][4][5]. Published data highlight both direct and indirect virus-related kidney damage [7].…”

Section: Discussionmentioning

confidence: 99%

“…The novel coronavirus (SARS-CoV-2) infection has rapidly become a pandemic, with an aggressive and even fatal course in adults with comorbidities, and milder clinical manifestations in children [1]. Children with chronic kidney disease (CKD) or on immunosuppression for nephrotic syndrome, glomerular diseases, or transplantation show neither a more severe clinical course nor an increased risk of infection, compared to healthy peers [2][3][4][5]. SARS-CoV-2 nephropathy has been reported in both healthy adults and children.…”

Section: Introductionmentioning

confidence: 99%

Kidney involvement and histological findings in two pediatric COVID-19 patients

et al. 2021

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Background Histological findings of kidney involvement have been rarely reported in pediatric patients with SARS-CoV-2 infection. Here, we describe clinical, laboratory, and histological findings of two pediatric cases with almost exclusive kidney involvement by SARS-CoV-2. Results A 10-year-old girl with IgA vasculitis nephritis underwent kidney biopsy, showing diffuse and segmental mesangial-proliferative glomerulonephritis, and steroid therapy was initiated. After the worsening of the clinical picture, including an atypical skin rash, she was diagnosed with SARS-CoV-2. The re-evaluation of initial biopsy showed cytoplasmatic blebs and virus-like particles in tubular cells at electron microscopy. Despite SARS-CoV-2 clearance and the intensification of immunosuppression, no improvement was observed. A second kidney biopsy showed a crescentic glomerulonephritis with sclerosis, while virus-like particles were no longer evident. The second patient was a 12-year-old girl with a 3-week history of weakness and weight loss. Rhinitis was reported the month before. No medications were being taken. Blood and urine analysis revealed elevated serum creatinine, hypouricemia, low molecular weight proteinuria, and glycosuria. A high SARS-CoV-2-IgG titre was detected. Kidney biopsy showed acute tubular-interstitial nephritis. Steroid therapy was started with a complete resolution of kidney involvement. Conclusion We can speculate that in both cases SARS-CoV-2 played a major role as inflammatory trigger of the kidney damage. Therefore, we suggest investigating the potential kidney damage by SARS-CoV-2 in children. Moreover, SARS-CoV-2 can be included among infectious agents responsible for pediatric acute tubular interstitial nephritis.

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“…While patients with CKD were included in SARS-CoV-2 antibody surveys, specific serological data in this population is lacking. Data collected from children with kidney diseases showed low prevalence of anti-SARS-CoV-2 antibodies early in the course of the pandemic [29]. However, serological studies in children with kidney disease after PCRconfirmed COVID-19 are lacking.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 in children and young adults with kidney disease: risk factors, clinical features and serological response

et al. 2021

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Background Chronic kidney disease (CKD) and kidney transplantation in adults are well-recognized risk factors for coronavirus disease 2019 (COVID-19) associated morbidity and mortality. Data on the toll of the pandemic on children and young adults with kidney disease is scarce. The aim of this study was to assess the incidence and severity of COVID-19, as well as the serological response, in this population. Methods Study population included all patients with CKD stage 3-5, glomerular disease treated with immunosuppression and kidney transplant recipients followed-up at a tertiary medical center, between 1.12.2020 and 15.2.2021. Data collected included PCR testing, symptoms, exposure, and socio-demographic data. Anti-SARS-CoV-2 antibodies were tested. Results A total of 197 children and 63 young adults were included, 57% were Jewish, 43% were Arab. PCR-confirmed COVID-19 incidence was 20.8%, 37% of cases were asymptomatic, three patients were hospitalized for observation, and the remainder had mild symptoms. Kidney function remained stable without treatment modification. Risk factors for infection included exposure at home (OR 15.4, 95% CI 6.9-34.2) and number of household members (OR 1.45, 95% CI 1.21-1.73). Anti-SARS-CoV-2 antibodies were detected in 61% of cases and were not associated with COVID-19 severity or immunosuppressive therapy. Three patients who did not develop antibodies had a mild recurrent infection. Conclusions Unlike COVID-19 in adult patients with kidney disease, in our cohort of children and young adults, COVID-19 incidence was similar to the general population and all cases were mild. It may be unnecessary to impose severe restrictions on this patient population during the pandemic.

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Prevalence of SARS-CoV-2-IgG Antibodies in Children with CKD or Immunosuppression

Cited by 8 publications

References 5 publications

COVID-19 and idiopathic nephrotic syndrome in children: systematic review of the literature and recommendations from a highly affected area

COVID-19 and idiopathic nephrotic syndrome in children: systematic review of the literature and recommendations from a highly affected area

Kidney involvement and histological findings in two pediatric COVID-19 patients

COVID-19 in children and young adults with kidney disease: risk factors, clinical features and serological response

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