Acute Kidney Injury Seen in Kids With COVID-19 and MIS-C

NEW YORK (Reuters Health) – Children hospitalized with acute COVID-19 infection and multisystem inflammatory syndrome (MIS-C) may develop acute kidney injury, according to a new report.

“In general, it seems that children get less severely ill with COVID, but if they are hospitalized, the medical community should realize that acute kidney injury can occur,” Dr. Christine Sethna of Cohen Children’s Medical Center, in New Hyde Park, New York, said in a phone interview with Reuters Health.

Dr. Sethna and colleagues took a look back at 152 children aged 18 and younger who were admitted to four New York hospitals with the Northwell Health System, including 97 (64%) with acute COVID-19 and 55 (36%) with MIS-C.

Overall, acute kidney injury (AKI) developed in 18 children (12%), including eight children (8%; median age, 8.2 years; more than half male) with acute COVID-19 and 10 children (18%; median age, 7.5 years; 60% male) with MIS-C.

Dr. Sethna noted that the incidence of AKI in children with COVID-19 or MIS-C reported in the literature has been highly variable.

“For example, in Wuhan the incidence was 1.2% but it’s been ranging up to about 44% in the really sick kids MIS-C, so we’re kind of in the middle. And that’s because the numbers are small, in general, for children who’ve been admitted to hospitals and various definitions have been used to define acute kidney injury,” she explained.

Prior research from The Feinstein Institutes for Medical Research, the research arm of Northwell Health, showed that over a third of adults treated for COVID-19 in the Northwell Health System developed AKI and nearly 15% required dialysis (

Most children in the current cohort developed AKI on admission and 99% were critically ill with high rates of mechanical ventilation and need for vasoactive support. In unadjusted models, AKI was significantly associated with longer time spent in the hospital and in the pediatric intensive-care unit.

Lower serum albumin and higher white blood cell count were associated with AKI in children with acute COVID-19 and MIS-C, “which may reflect the inflammatory cascade’s complex role in development and perpetuation of AKI,” the researchers note in their paper in Kidney International.

In addition, children with MIS-C and AKI had significantly greater rates of systolic dysfunction, compared to those without (80% vs. 49%).

Dr. Sethna said in all but two cases, acute kidney injury resolved before hospital discharge.

Further research in larger pediatric cohorts is needed to better characterize risk factors for AKI in association with COVID-19 and MIS-C as well as any long term effects of acute kidney injury, such as high blood pressure or chronic kidney disease, she added.

SOURCE: Kidney International, online March 3, 2021.

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