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Acute kidney injury in children with moderate-severe COVID-19 and multisystem inflammatory syndrome in children: a referral center experience.

Authors
  • Tastemel Ozturk, Tugba1
  • Düzova, Ali2
  • Oygar, Pembe Derin3
  • Baltu, Demet1
  • Ozcilingir Hakverdi, Pelin4
  • Lacinel Gurlevik, Sibel3
  • Kurt-Sukur, Eda Didem1
  • Aykan, Hayrettin Hakan5, 6
  • Ozen, Seza7
  • Ertugrul, Ilker5
  • Kesici, Selman6, 8
  • Gulhan, Bora1
  • Ozaltin, Fatih1
  • Ozsurekci, Yasemin3
  • Cengiz, Ali Bulent3
  • Topaloglu, Rezan1
  • 1 Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
  • 2 Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye. [email protected].
  • 3 Division of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
  • 4 Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
  • 5 Division of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
  • 6 Life Support Center, Hacettepe University, Ankara, Türkiye.
  • 7 Division of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
  • 8 Division of Pediatric Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
Type
Published Article
Journal
Pediatric Nephrology
Publisher
Springer-Verlag
Publication Date
Mar 01, 2024
Volume
39
Issue
3
Pages
867–877
Identifiers
DOI: 10.1007/s00467-023-06125-3
PMID: 37676500
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Data on the characteristics of acute kidney injury (AKI) in pediatric COVID-19 and MIS-C are limited. We aimed to define the frequency, associated factors and early outcome of AKI in moderate, severe or critical COVID-19 and MIS-C; and to present a tertiary referral center experience from Türkiye. Hospitalized patients ≤ 18 years of age with confirmed COVID-19 or MIS-C at İhsan Doğramacı Children's Hospital, Hacettepe University, between March 2020-December 2021 were enrolled. The characteristics of AKI in the COVID-19 group were investigated in moderate, severe and critically ill patients; patients with mild COVID-19 were excluded. The median (Q1-Q3) age in the COVID-19 (n = 66) and MIS-C (n = 111) groups was 10.7 years (3.9-15.2) and 8.7 years (4.5-12.7), respectively. The frequency of AKI was 22.7% (15/66) in COVID-19 and 15.3% (17/111) in MIS-C; all MIS-C patients with AKI and 73.3% (11/15) of COVID-19 patients with AKI had AKI at the time of admission. Multivariate analyses revealed need for vasoactive/inotropic agents [Odds ratio (OR) 19.233, p = 0.002] and presence of vomiting and/or diarrhea (OR 4.465, p = 0.036) as independent risk factors of AKI in COVID-19 patients; and need for vasoactive/inotropic agents (OR 22.542, p = 0.020), procalcitonin and ferritin levels as independent risk factors of AKI in the MIS-C group. Age was correlated with lymphocyte count (r = -0.513, p < 0.001) and troponin level (r = 0.518, p < 0.001) in MIS-C patients. Length of hospital stay was significantly longer in both groups with AKI, compared to those without AKI. Mortality was 9.1% in the COVID-19 group; and was associated with AKI (p = 0.021). There was no mortality in MIS-C patients. AKI recovery at discharge was 63.6% in COVID-19 survivors and 100% in MIS-C patients. Independent risk factors for AKI were need for vasoactive/inotropic agents and vomiting/diarrhea in moderate, severe or critical COVID-19 patients; and need for vasoactive/inotropic agents and severe inflammation in MIS-C patients. Our findings suggest that inflammation and cardiac dysfunction are associated with AKI in MIS-C patients; and the association with age in this group merits further studies in larger groups. Early outcome is favorable; long-term follow-up for kidney functions is needed. © 2023. The Author(s), under exclusive licence to International Pediatric Nephrology Association.

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