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El-Halaby H, Eid R, Elagamy A, El-Hussiny A, Moustafa F, Hammad A, Zeid M. A retrospective analysis of acute kidney injury in children with post-COVID-19 multisystem inflammatory syndrome: insights into promising outcomes. Ital J Pediatr 2024; 50:23. [PMID: 38317228 PMCID: PMC10845792 DOI: 10.1186/s13052-024-01598-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/21/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) in patients with multisystem inflammatory syndrome (MIS), COVID-19 related infection has been increasingly recognized with a paucity of data on AKI incidence, related mortality, and the requirement of renal replacement therapy in children with MIS (MIS-C). METHODS This is a retrospective study evaluating the prevalence, severity, management and outcomes of AKI in a cohort of Egyptian children with MIS-children (MIS-C) post-COVID infection. Patients were included if they met the criteria for MIS-C based on CDC guidelines. All patients were evaluated for AKI diagnosis and staging according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. RESULTS Between March 2021 and June 2023, a total of 655 confirmed COVID-19 cases were admitted and then followed up in our hospital, of whom 138 (21%) were diagnosed with MIS-C. Fifty-one patients developed AKI associated with MIS-C post-COVID infection, 42 of whom were included in the analysis. Thirty-one patients had AKI in a formerly healthy kidney, of whom 51% (16 patients) were classified as KDIGO stage 3, 5 patients needed hemodialysis and 13 needed mechanical ventilation. Higher WBCs count, and serum ferritin on admission were associated with more severe AKI (KDIGO stage 3) (p = 0.04), while multivariate analysis showed high serum ferritin to be independent predictor of more severe AKI (p = 0.02). Two patients (2/31) died during hospital admission, while no residual renal impairment was reported at the time of discharge of patients with previously normal kidney functions. CONCLUSION More than one-third of patients with MIS-C develop AKI. Avoidance of nephrotoxic drugs, early recognition, and prompt management of AKI, including well-timed commencement of dialysis in MIS-C cases, is associated with favorable outcomes.
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Affiliation(s)
- Hanan El-Halaby
- Pediatric Critical Care Unit, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Riham Eid
- Pediatric Nephrology Unit, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Ahmed Elagamy
- Pediatric Critical Care Unit, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed El-Hussiny
- Pediatric Critical Care Unit, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Fatma Moustafa
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ayman Hammad
- Pediatric Nephrology Unit, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mayada Zeid
- Pediatric Infectious Diseases Unit, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Meneghel A, Masenello V, Alfier F, Giampetruzzi S, Sembenini C, Martini G, Tirelli F, Meneghesso D, Zulian F. Renal Involvement in Multisystem Inflammatory Syndrome in Children: Not Only Acute Kidney Injury. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1661. [PMID: 37892324 PMCID: PMC10605058 DOI: 10.3390/children10101661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/15/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023]
Abstract
Kidney involvement has been poorly investigated in SARS-CoV-2 Multisystem Inflammatory Syndrome in Children (MIS-C). To analyze the spectrum of renal involvement in MIS-C, we performed a single-center retrospective observational study including all MIS-C patients diagnosed at our Pediatric Department between April 2020 and May 2022. Demographic, clinical, pediatric intensive care unit (PICU) admission's need and laboratory data were collected at onset and after 6 months. Among 55 MIS-C patients enrolled in the study, kidney involvement was present in 20 (36.4%): 13 with acute kidney injury (AKI) and 7 with isolated tubular dysfunction (TD). In eight patients, concomitant AKI and TD was present (AKI-TD). AKI patients needed higher levels of intensive care (PICU: 61.5%, p < 0.001; inotropes: 46.2%, p = 0.002; second-line immuno-therapy: 53.8%, p < 0.001) and showed lower levels of HCO3- (p = 0.012), higher inflammatory markers [neutrophils (p = 0.092), PCT (p = 0.04), IL-6 (p = 0.007)] as compared to no-AKI. TD markers showed that isolated TD presented higher levels of HCO3- and lower inflammatory markers than AKI-TD. Our results indicate a combination of both pre-renal and inflammatory damage in the pathogenesis of kidney injury in MIS-C syndrome. We highlight, for the first time, the presence of tubular involvement in MIS-C, providing new insights in the evaluation of kidney involvement and its management in this condition.
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Affiliation(s)
- Alessandra Meneghel
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Valentina Masenello
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Fiorenza Alfier
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Stefania Giampetruzzi
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Camilla Sembenini
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Giorgia Martini
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Francesca Tirelli
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Davide Meneghesso
- Pediatric Nephrology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Francesco Zulian
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
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Özen H, Aslan AD, Balaban B, Perk O, Uçmak H, Özcan S, Gurbanov A, Uyar E, Kahveci F, Gün E, Tehci AK, Emeksiz S, Kendirli T. Acute kidney injury in critically ill children with COVID-19 and MIS-C. Pediatr Nephrol 2023; 38:3475-3482. [PMID: 37171582 PMCID: PMC10177713 DOI: 10.1007/s00467-023-05987-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND This study's objective was to investigate the incidence of acute kidney injury (AKI) in children with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and multisystem inflammatory syndrome (MIS-C) and to report our clinical experience. METHODS Acute COVID-19 and MIS-C-diagnosed patients observed in two pediatric intensive care units (PICUs) between 2019 and 2021 were examined for AKI and retrospectively compared to children with AKI. RESULTS The study comprised 163 children, of whom 98 (60.1%) were diagnosed with acute COVID-19 and 65 (39.9%) with MIS-C. AKI was observed in 40 (40.8%) of the acute COVID-19 patients and 18 (27.7%) of the MIS-C patients. Low calcium level and hypotension were linked with AKI at initial presentation (OR: 0.56, 95% CI: 0.369-0.560, p = 0.006 and OR: 3.64, 95% CI: 1.885-7.152, p = 0.001, respectively). A history of nephrotoxic medication usage played an essential role in the development of AKI in patients who acquired AKI after hospitalization (p = 0.001, odds ratio: 9.32, confidence interval: 3.106-27.973). In clinical practice, individuals with respiratory distress and cough had a high chance of having AKI (OR: 4.47, 95% confidence interval: 2.25-8,892 and OR: 3.48, 95% confidence interval: 1.76-6.88). AKI patients had a greater demand for respiratory assistance and a longer period of stay in the PICU. CONCLUSIONS AKI in the COVID-19 and MIS-C patient groups is related with increased mortality and extended hospitalization, according to the findings. These statistics imply that identifying and preventing risk factors is necessary. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Hasan Özen
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey.
| | - Ayşen Durak Aslan
- Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Burak Balaban
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Oktay Perk
- Department of Pediatric Intensive Care Unit, Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Hacer Uçmak
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Serhan Özcan
- Department of Pediatric Intensive Care Unit, Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Anar Gurbanov
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Emel Uyar
- Department of Pediatric Intensive Care Unit, Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Fevzi Kahveci
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Emrah Gün
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Kansu Tehci
- Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Serhat Emeksiz
- Department of Pediatric Intensive Care Unit, Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey
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Albanji MH, Baghafar AA, Alghanmi YA, Shaaban MM, Alkashlan EA, Sende HH, Alzahrani MS, Filfilan NN. Clinical Presentation and Management of Multisystem Inflammatory Syndrome in Children With COVID-19: A Systematic Review. Cureus 2023; 15:e46918. [PMID: 37954764 PMCID: PMC10639140 DOI: 10.7759/cureus.46918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a relatively new syndrome associated with coronavirus disease 2019 (COVID-19) that is characterized by a severe clinical course compared to pediatric COVID-19. This review aimed to compile the available evidence on the clinical presentation and management of MIS-C in children with COVID-19. During this systematic review, a comprehensive search was performed in the following databases: PubMed, Embase, Medline, Google Scholar, Cochrane, and Scopus, using predetermined search terms, such as Medical Subject Headings (MeSH) and keywords to find relevant studies on the MIS-C. Relevant data were extracted, and the quality of the studies was evaluated using suitable methods. The collected findings were synthesized and discussed in the study. The World Health Organization's (WHO) definition of MIS-C was the most favored due to its precision and inclusiveness. MIS-C primarily affected children aged 6-12 years, with male predominance. MIS-C involves a range of systems, including gastrointestinal, cardiovascular, hematologic, mucocutaneous, and respiratory. Radiographic findings revealed cardiovascular abnormalities, solid visceral organ involvement, and bowel abnormalities, reflecting a systemic inflammatory process. Laboratory investigations unveiled elevated inflammatory markers, neutrophil activation, release of extracellular traps in vessels, elevated procalcitonin, hyponatremia, hypoalbuminemia, low hemoglobin, and thrombocytopenia. The inflammatory markers and autoantibody profiles are essential in differentiating MIS-C from COVID-19. The preferred treatment primarily involves immunomodulatory therapies like intravenous immunoglobulin (IVIG), glucocorticoids, and interleukin-6 or 1RA inhibitors or a combination of those. In severe cases, extracorporeal membrane oxygenation (ECMO) and mechanical ventilation are necessary, leading to reduced mortality and quick recovery. This review found that the average hospital stay was seven days, and most discharged children fully recovered within seven days. MIS-C is a life-threatening post-COVID-19 condition and involves multiple systems due to systemic inflammation, with elevated inflammation markers. Recognition of multisystem involvement is crucial, and prompt identification and multidisciplinary treatment are vital for optimal outcomes.
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Affiliation(s)
| | | | | | | | | | - Haifa H Sende
- Pediatrics, Royal Commission Medical Center, Yanbu, SAU
| | | | - Nuha N Filfilan
- Family and Community Medicine, College of Medicine, Taif University, Taif, SAU
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5
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Baek HS, Cho MH. Kidney complications associated with COVID-19 infection and vaccination in children and adolescents: a brief review. Clin Exp Pediatr 2023; 66:424-431. [PMID: 37402469 PMCID: PMC10556799 DOI: 10.3345/cep.2023.00738] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has spread considerably across the globe, affecting numerous children and adolescents besides adults. Despite its relatively lower incidence rates in children and adolescents than in adults, some infected children and adolescents exhibit a severe postinflammatory response known as multisystem inflammatory syndrome in children, followed by acute kidney injury, a common complication. Meanwhile, few reports have been available regarding kidney complications such as idiopathic nephrotic syndrome and other glomerulopathies associated with COVID-19 infection and vaccination in children and adolescents. However, the morbidity and mortality of these complications are not exceptionally high; more importantly, causality has yet to be clearly established. Finally, vaccine hesitancy in these age groups should be addressed, considering the strong evidence of COVID-19 vaccine safety and efficacy.
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Affiliation(s)
- Hee Sun Baek
- Department of Pediatrics, Yeungnam University, College of Medicine, Daegu, Korea
| | - Min Hyun Cho
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
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Orsi SM, Pepino C, Rossoni L, Serafino M, Caorsi R, Volpi S, Palmeri S, Faragli A, Lugani F, Bigatti C, Ghiggeri GM, Verrina EE, La Porta E, Angeletti A. Case Report: Multisystem inflammatory syndrome in children with associated proximal tubular injury. FRONTIERS IN NEPHROLOGY 2023; 3:1194989. [PMID: 37675350 PMCID: PMC10479668 DOI: 10.3389/fneph.2023.1194989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/30/2023] [Indexed: 09/08/2023]
Abstract
Introduction SARS-CoV-2 infection in the pediatric population can be associated with a multiorgan inflammatory syndrome called children's multisystem inflammatory syndrome (MIS-C). The kidneys can be affected by a broad spectrum of possible injuries, whose pathogenetic mechanisms are still unclear.Case report: We report the case of a 5-year-old boy with severe cardiac involvement in the context of MIS-C. After two weeks of hospitalization, an abdominal ultrasound showed massive bladder "debris", followed by the onset of normoglycemic glycosuria. Over time, there was a progressive increase in glycosuria, and the presence of a mat of amorphous phosphate crystals was evidenced on urinary sediment. Together with the findings of hypo-uricemia, increased urinary uric acid, and globally increased urinary amino acids, a clinical picture of kidney proximal tubular damage with secondary Fanconi-like syndrome took shape. Discussion This case report describes the case of a patient with MIS-C with cardiac and kidney involvement characterized by proximal tubular damage, which slowly improved but still persisted at the 8-month follow-up. The pathogenesis of the damage is unclear and probably multifactorial.
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Affiliation(s)
- Silvia Maria Orsi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Carlotta Pepino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Lisa Rossoni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Margherita Serafino
- Department of Pediatric Cardiology and Cardiac Surgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Roberta Caorsi
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Stefano Volpi
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Serena Palmeri
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Faragli
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Francesca Lugani
- Division of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Carolina Bigatti
- Division of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gian Marco Ghiggeri
- Division of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Enrico Eugenio Verrina
- Division of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Dialysis Unit, Department of Pediatric, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Edoardo La Porta
- Division of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Dialysis Unit, Department of Pediatric, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Angeletti
- Division of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Fu HJ, Zhou M, Huang ZH, Chen YX, Wu XX. Severe acute hepatitis of unknown origin in children: Clinical issues of concern. J Transl Int Med 2023; 11:19-23. [PMID: 37533848 PMCID: PMC10393056 DOI: 10.2478/jtim-2023-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Affiliation(s)
- Hai-Jing Fu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qing Chun Road, Hangzhou 310003, Zhejiang Province, China
| | - Min Zhou
- Department of Respiratory and Infectious Diseases, People’s Hospital of AnJi, Huzhou313300, Zhejiang Province, China
| | - Zhi-Hui Huang
- Department of Respiratory and Infectious Diseases, People’s Hospital of AnJi, Huzhou313300, Zhejiang Province, China
| | - Yong-Xu Chen
- Group of Gene Regulation in Stem Cells, Cell Plasticity, Differentiation, and Cancer, IDIBAPS, Barcelona08036, Spain
| | - Xiao-Xin Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qing Chun Road, Hangzhou 310003, Zhejiang Province, China
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Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection in KwaZulu-Natal, South Africa. Pediatr Infect Dis J 2023; 42:e9-e14. [PMID: 36476527 PMCID: PMC9725742 DOI: 10.1097/inf.0000000000003759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been infrequently described in Africa. OBJECTIVE To describe the clinical characteristics, outcomes and associations of severe disease in children hospitalized with MIS-C in KwaZulu-Natal. METHODS Retrospective multicenter study of children (0-13 years) who met the Centers for Disease Control and Prevention criteria for MIS-C. Children with shock were compared with children without shock to determine the characteristics of severe MIS-C. RESULTS Twenty-nine children with MIS-C were identified, the mean age was 55 (SD ±45) months, 25 (86%) were Black-African, and 8 (28%) had pre-existing comorbidities. The predominant presenting symptoms included fever 29 (100%), gastrointestinal symptoms 25 (83%), skin rash 19 (65%), and shock 17 (59%). Children with shock had significantly increased CRP (P = 0.01), ferritin (P < 0.001), troponin-T (P = 0.02), B-type natriuretic peptide (BNP) (P = 0.01), and lower platelets (P = 0.01). Acute kidney injury (P = 0.01), cardiac involvement (P = 0.02), and altered levels of consciousness (P = 0.03) were more common in children with shock. The median length of hospital stay was 11 (IQR 7-19) days, with a mortality of 20.6%. Children who did not survive had significantly higher ferritin levels 1593 (IQR 1069-1650) ng/mL versus 540 (IQR 181-1156) ng/mL; P = 0.03) and significantly more required mechanical ventilation (OR 18; confidence interval 1.7-191.5; P = 0.005). CONCLUSIONS Hospitalized children with MIS-C in KwaZulu-Natal had more aggressive disease and higher mortality than children in better-resourced settings. Markedly elevated biomarkers and critical organ involvement were associated with severe disease. Risk factors for poor outcomes include higher ferritin levels and the need for mechanical ventilation.
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Tripathi AK, Pilania RK, Bhatt GC, Atlani M, Kumar A, Malik S. Acute kidney injury following multisystem inflammatory syndrome associated with SARS-CoV-2 infection in children: a systematic review and meta-analysis. Pediatr Nephrol 2023; 38:357-370. [PMID: 35943577 PMCID: PMC9362633 DOI: 10.1007/s00467-022-05701-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Multisystem inflammatory syndrome (MIS-C) is a rare paediatric hyper-inflammatory disorder that occurs following SARS-CoV-2 infection. Acute kidney injury (AKI) occurs in approximately one-quarter to one-third of the patients with MIS-C and is associated with poor prognosis in critically ill children. This systematic review is aimed to evaluate the incidence of AKI, mortality, and the need for kidney replacement therapy (KRT) in patients with MIS-C. METHODS We searched databases from Medline, EMBASE, Cochrane Register, and Google Scholar from December 2019 to December 2021 with our search strategy. Studies meeting the following criteria were included in this systematic review: (1) articles on AKI in MIS-C; (2) studies providing AKI in MIS-C and COVID-19 infection separately; (3) studies reporting outcomes such as mortality, KRT, serum creatinine; length of hospital/ICU stay. QUALITY ASSESSMENT The quality of the included studies was independently assessed by using the National Heart Lung and Blood Institute (NHLBI) quality assessment tool for cohort studies and case series. STATISTICAL ANALYSIS Outcomes and their 95% confidence intervals (CI) were reported if a meta-analysis of these outcomes was conducted. Heterogeneity was reported using I2 statistics, and heterogeneity ≥ 50% was considered high. We used Baujat's plot for the contribution of each study toward overall heterogeneity. In sensitivity analysis, the summary estimates were assessed by repeating meta-analysis after omitting one study at a time. Forest plots were used for reporting outcomes in each study and with their 95% CI. All statistical tests were performed using R software version 4.0.3. RESULTS A total of 24 studies were included in this systematic review and of these, 11 were included in the meta-analysis. The pooled proportion of patients with MIS-C developing AKI was 20% (95% CI: 14-28%, I2 = 80%). Pooled proportion of death in children with MIS-C was 4% (95% CI: 1-14%; I2 = 93%). The odds of death in patients with AKI were 4.68 times higher than in patients without AKI (95% CI: 1.06-20.7%; I2 = 17%). The overall pooled proportion of MIS-C-induced AKI patients requiring KRT was 15% (95% CI: 4-42%; I2 = 91%). CONCLUSION Approximately one-fifth of children with MIS-C develop AKI which is associated with higher odds of death. PROSPERO registration: CRD42022306170 A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Anchal Kumar Tripathi
- Department of Pediatrics, ISN-SRC, All India Institute of Medical Sciences (AIIMS), Room no 1023, Academic Block, Saket Nagar, Bhopal, MP 462024 India
| | - Rakesh Kumar Pilania
- Advanced Pediatrics Centre, Division of Clinical Immunology and Rheumatology, Post Graduate Institute of Medical Sciences (PGI), Chandigarh, India
| | - Girish Chandra Bhatt
- Department of Pediatrics, ISN-SRC, All India Institute of Medical Sciences (AIIMS), Room no 1023, Academic Block, Saket Nagar, Bhopal, MP, 462024, India.
| | - Mahendra Atlani
- Department of Nephrology, All India Institute of Medical Sciences (AIIMS), Bhopal, MP India
| | - Amber Kumar
- Department of Pediatrics, ISN-SRC, All India Institute of Medical Sciences (AIIMS), Room no 1023, Academic Block, Saket Nagar, Bhopal, MP 462024 India
| | - Shikha Malik
- Department of Pediatrics, ISN-SRC, All India Institute of Medical Sciences (AIIMS), Room no 1023, Academic Block, Saket Nagar, Bhopal, MP 462024 India
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Almatrafi MA, Kabli AF, Subahi Y, Yaseen E, Alsahaf N, Alidrisi D, Ahmed HA, Masmali HM, Alahmad O, Khan MN, Minshawi F. A Rare Case of a Child Diagnosed With Multisystem Inflammatory Syndrome After COVID-19 Presenting With Renal Infarctions and Transient Blast Cells: A Case Report and Literature Review. Cureus 2022; 14:e30832. [DOI: 10.7759/cureus.30832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
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11
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Multisystem Inflammatory Syndrome in Children and Acute Kidney Injury: Retrospective Study of Five Italian PICUs. Pediatr Crit Care Med 2022; 23:e361-e365. [PMID: 35435870 DOI: 10.1097/pcc.0000000000002955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Multisystem inflammatory syndrome in children (MIS-C) manifests with heart dysfunction and respiratory failure some weeks after a severe acute respiratory syndrome coronavirus disease 2 infection. The aim of our study was to explore the prevalence, severity, timing, and duration of acute kidney injury (AKI) in MIS-C patients. Furthermore, we evaluated which clinical variables and outcomes are associated with AKI. DESIGN Multicenter retrospective study. SETTING Five tertiary hospital PICUs in Italy. Data were collected in the first 7 days of PICU admission and renal function was followed throughout the hospital stay. PATIENTS Patients less than 18 years old admitted to the PICU for greater than 24 hours with MIS-C. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We collected the following data, including: demographic information, inflammatory biomarkers, lactate levels, Pa o2 /F io2 , ejection fraction, N-terminal pro-B-type natriuretic peptide (NT-proBNP), renal function (serum creatinine, urinary output, fluid balance, and percentage fluid accumulation), Vasoactive-Inotropic Score (VIS), pediatric Sequential Organ Failure Assessment (pSOFA), and Pediatric Index of Mortality 3. AKI was diagnosed in eight of 38 patients (21%) and severe AKI was present in four of eight patients. In all cases, AKI was present at PICU admission and its median (interquartile range) duration was 3.5 days (1.5-5.7 d). We did not identify differences between AKI and no-AKI patients when not making correction for multiple comparisons, for example, in weight, ejection fraction, pSOFA, Pa o2 /F io2 , and lactates. We failed to identify any difference in these groups in urine output and fluid balance. Exploratory analyses of serial data between no-AKI and AKI patients showed significant differences on lymphocyte count, NT-proBNP value, ejection fraction, pSOFA, Pa o2 /F io2 , and VIS. CONCLUSIONS In this multicenter Italian PICU experience, MIS-C is associated with AKI in one-in-five cases. In general, AKI is characterized by an associated reduction in glomerular filtration rate with a self-limiting time course.
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Duong-Quy S, Huynh-Truong-Anh D, Le-Thi-Hong N, Le-Van T, Le-Thi-Kim S, Nguyen-Quang T, Nguyen-Thi-Kim T, Nguyen-Phuong N, Nguyen-Chi T, Nguyen-Van T, Duong-Thi-Thanh V, Nguyen-Tien D, Ngo C, Craig T. Acute Respiratory Distress Syndrome Associated with Multisystem Inflammatory Syndrome in a Child with Covid-19 and Diabetic Ketoacidosis: A Case Report. Pulm Ther 2022; 8:333-342. [PMID: 35608797 PMCID: PMC9127484 DOI: 10.1007/s41030-022-00192-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/12/2022] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus disease 2019 (Covid-19), has uncontrollable effects on many organs. A great number of previously published scientific reports have revealed that patients with diabetes mellitus face a more severe form of Covid-19 with a higher death rate. Here we present the case of a 13-year-old unvaccinated boy who was admitted to an intensive care unit (ICU) with a history of fever, cough, dyspnea, throat pain, nausea, and confusion that progressed to lethargy after 24 h. On clinical examination, he was in a coma with Kussmaul’s breathing, and was anuric. His blood biochemical analysis demonstrated hyperglycemia, severe metabolic acidosis, kidney failure, electrolyte disturbances, and inflammation. Chest x-ray showed pneumonia and a pleural effusion. The results of the SARS-CoV-2 real-time polymerase chain reaction were positive. The patient was diagnosed with Covid-19-induced acute respiratory distress syndrome associated with multisystem inflammatory syndrome in children secondary to his acute respiratory failure, acute kidney injury, and new-onset type 1 diabetes mellitus with diabetic ketoacidosis. He was intubated for invasive mechanical ventilation and received a normal saline infusion and continuous insulin infusion (0.1 IU/kg/h) for the treatment of his diabetic ketoacidosis. He was also treated with methylprednisolone, aspirin, and heparin, and underwent continuous renal replacement therapy for acute renal failure for 9 days. The patient was discharged from ICU on day 16 and was followed up regularly as an outpatient with daily treatment, including subcutaneous insulin injection (30 IU/day) and a calcium channel blocker for hypertension (nifedipine 20 mg/day).
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Affiliation(s)
- Sy Duong-Quy
- Biomedical Research Center, Lam Dong Medical College, Da Lat, Vietnam. .,Covid-19 Unit of Phu Chanh, Binh Duong General Hospital, Binh Duong, Vietnam. .,Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, PA, USA.
| | | | - Nhung Le-Thi-Hong
- Covid-19 Unit of Phu Chanh, Binh Duong General Hospital, Binh Duong, Vietnam
| | - Tap Le-Van
- Covid-19 Unit of Phu Chanh, Binh Duong General Hospital, Binh Duong, Vietnam
| | - Sa Le-Thi-Kim
- Covid-19 Unit of Phu Chanh, Binh Duong General Hospital, Binh Duong, Vietnam
| | - Tien Nguyen-Quang
- Covid-19 Unit of Phu Chanh, Binh Duong General Hospital, Binh Duong, Vietnam
| | | | - Ngan Nguyen-Phuong
- Covid-19 Unit of Phu Chanh, Binh Duong General Hospital, Binh Duong, Vietnam
| | - Thanh Nguyen-Chi
- Covid-19 Unit of Phu Chanh, Binh Duong General Hospital, Binh Duong, Vietnam
| | - Tinh Nguyen-Van
- Covid-19 Unit of Phu Chanh, Binh Duong General Hospital, Binh Duong, Vietnam
| | - Van Duong-Thi-Thanh
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Dung Nguyen-Tien
- Department of Pediatric Intensive Care Unit, Bach Mai Hospital, Hanoi, Vietnam
| | - Carine Ngo
- Department of Pathology, Institute Gustave Roussy, Villejuif, France
| | - Timothy Craig
- Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, PA, USA
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Acevedo L, Piñeres-Olave BE, Niño-Serna LF, Vega LM, Gomez IJA, Chacón S, Jaramillo-Bustamante JC, Mulett-Hoyos H, González-Pardo O, Zemanate E, Izquierdo L, Mejìa JP, González JLJ, Duran BG, Gonzalez CB, Preciado H, Marun RO, Alvarez-Olmos MI, Alzate CG, Rojas J, Salazar-Uribe JC, Anaya JM, Fernández-Sarmiento J. 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). BMC Pediatr 2021; 21:516. [PMID: 34794410 PMCID: PMC8600488 DOI: 10.1186/s12887-021-02974-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 10/18/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. METHODS An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (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. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). 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. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children.
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Affiliation(s)
- Lorena Acevedo
- Department of Pediatrics and Intensive Care. Fundación Cardioinfantil-Instituto de Cardiología, Universidad de la Sabana, Bogotá, Colombia
| | | | | | - Liliana Mazzillo Vega
- Department of Pediatrics and Intensive Care, Hospital Infantil Los Ángeles, Pasto, Colombia
| | | | - Shayl Chacón
- Department of Pediatrics and Intensive Care, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Juan Camilo Jaramillo-Bustamante
- Department of Pediatrics and Intensive Care, Hospital General de Medellín, Universidad de Antioquia, Red Colaborativa Pediátrica de Latinoamérica (LARed Network, Medellín, Colombia
| | - Hernando Mulett-Hoyos
- Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad del Rosario, Bogotá, Colombia
| | - Otto González-Pardo
- Department of Pediatrics and Intensive Care, Fundación Clínica Shaio, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Eliana Zemanate
- Department of Pediatrics and Intensive Care, Hospital Susana Lopez de Valencia, Universidad del Cauca, Popayán, Colombia
| | - Ledys Izquierdo
- Department of Pediatrics and Intensive Care, Hospital Militar Central, Hospital Santa Clara, Bogotá, Colombia
| | - Jaime Piracoca Mejìa
- Department of Pediatrics and Intensive Care, Clínica Infantil de Colsubsidio, Bogotá, Colombia
| | | | - Beatriz Giraldo Duran
- Department of Pediatrics and Intensive Care, Hospital Infantil de la Cruz Roja Rafael Henao Toro, Manizales, Colombia
| | | | - Helen Preciado
- Department of Pediatrics and Intensive Care, Fundación Universitaria de Ciencias de la Salud. Hospital de San José, Bogotá, Colombia
| | - Rafael Orozco Marun
- Department of Pediatrics and Intensive Care, Clínica Portoazul, Puerto Colombia, Colombia
| | - Martha I Alvarez-Olmos
- Department of Pediatrics and Infectious Diseases, Fundación Cardioinfantil-Instituto de Cardiología, Universidad del Rosario, Bogotá, Colombia
| | | | - Jorge Rojas
- Department of Pediatrics and Intensive Care, Hospital Santa Clara, Bogotá, Colombia
| | | | - Juan-Manuel Anaya
- Center for Autoimmune Disease Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Jaime Fernández-Sarmiento
- Department of Pediatrics and Intensive Care. Fundación Cardioinfantil-Instituto de Cardiología, Universidad de la Sabana, Bogotá, Colombia.
- Universidad CES Graduate School, Medellín, Colombia.
- Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Cundinamarca, Chía, Colombia.
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Pilania RK, Dokania S, Kumar A, Ahmad R, Malik S, Bhatt GC. Acute Renal Failure Requiring Renal Replacement Therapy: Unusual Presentation of Multisystem Inflammatory Syndrome in Children. J Paediatr Child Health 2021; 57:1724-1725. [PMID: 34467603 DOI: 10.1111/jpc.15715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Rakesh K Pilania
- Department of Pediatrics, ISN-SRC, Pediatric Nephrology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Swati Dokania
- Department of Pediatrics, ISN-SRC, Pediatric Nephrology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Amber Kumar
- Department of Pediatrics, ISN-SRC, Pediatric Nephrology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Reyaz Ahmad
- Deparment of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Shikha Malik
- Department of Pediatrics, ISN-SRC, Pediatric Nephrology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Girish C Bhatt
- Department of Pediatrics, ISN-SRC, Pediatric Nephrology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
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Grewal MK, Gregory MJ, Jain A, Mohammad D, Cashen K, Ang JY, Thomas RL, Valentini RP. Acute Kidney Injury in Pediatric Acute SARS-CoV-2 Infection and Multisystem Inflammatory Syndrome in Children (MIS-C): Is There a Difference? Front Pediatr 2021; 9:692256. [PMID: 34434905 PMCID: PMC8380850 DOI: 10.3389/fped.2021.692256] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/14/2021] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Manpreet K. Grewal
- Division of Nephrology and Hypertension, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
| | - Melissa J. Gregory
- Division of Nephrology and Hypertension, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
| | - Amrish Jain
- Division of Nephrology and Hypertension, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
| | - Dunya Mohammad
- Division of Nephrology and Hypertension, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
| | - Katherine Cashen
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
- Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
| | - Jocelyn Y. Ang
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, United States
| | - Ronald L. Thomas
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
| | - Rudolph P. Valentini
- Division of Nephrology and Hypertension, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
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