Background

Acute kidney injury (AKI) is a common complication of critically ill adult patients with COVID-19. However, currently, no studies investigate kidney impairment in children with COVID-19. We investigated incidence and treatment of AKI in pediatric patients with COVID-19 in Wuhan Children’s Hospital during the early stages of the COVID-19 pandemic and discuss possible mechanisms of AKI related to SARS-CoV-2 infection.

Methods

By extracting data from electronic medical records, we conducted a retrospective observational study of kidney involvement in confirmed pediatric COVID-19 cases in Wuhan Children’s Hospital during the coronavirus outbreak, from January 24 to March 20, 2020. Clinical presentations, clinical courses, laboratory findings, and medical interventions are described below.

Results

Among 238 confirmed COVID-19 cases, only three were critically ill and needed intensive care unit (ICU) admission. All three developed AKI, but AKI was not detected in any non-critically ill patients outside the ICU. Two of the three patients with AKI had prodromal gastrointestinal symptoms. Significantly elevated interleukin-6 (IL-6) levels and complement activation were observed in these patients with AKI. The three patients with AKI were treated with plasma exchange (PE) and continuous kidney replacement therapy (CKRT), resulting in one complete recovery, one partial recovery, and one mortality due to critical illness.

Conclusions

Critically ill children with COVID-19 may develop AKI, especially following prodromal gastrointestinal symptoms. An inflammatory storm and complement-mediated injury may underlie AKI development in children with COVID-19. Our study supports implantation of PE and CKRT in management of critically ill patients with AKI.

中文翻译：

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请注意 COVID-19 重症儿童的急性肾损伤。

背景

急性肾损伤 (AKI) 是 COVID-19 成年重症患者的常见并发症。然而，目前还没有研究调查 COVID-19 患儿的肾功能损害。我们调查了 COVID-19 大流行早期武汉儿童医院 COVID-19 儿科患者 AKI 的发病率和治疗情况，并讨论了与 SARS-CoV-2 感染相关的 AKI 可能机制。

方法

通过从电子病历中提取数据，我们对 2020 年 1 月 24 日至 3 月 20 日冠状病毒爆发期间武汉儿童医院确诊的儿科 COVID-19 病例的肾脏受累情况进行了回顾性观察研究。临床表现、临床课程、实验室检查结果, 和医疗干预如下所述。

结果

在 238 例确诊的 COVID-19 病例中，只有 3 例病情危重，需要入住重症监护室 (ICU)。三人均出现 AKI，但在 ICU 外的任何非危重患者中均未检测到 AKI。三名 AKI 患者中有两名有前驱胃肠道症状。在这些 AKI 患者中观察到显着升高的白细胞介素 6 (IL-6) 水平和补体激活。3例AKI患者接受血浆置换（PE）和持续肾脏替代治疗（CKRT）治疗，1例完全康复，1例部分康复，1例因危重病亡。

结论

患有 COVID-19 的重症儿童可能会发生 AKI，尤其是在前驱胃肠道症状之后。炎症风暴和补体介导的损伤可能是 COVID-19 儿童发生 AKI 的基础。我们的研究支持在 AKI 重症患者的管理中植入 PE 和 CKRT。