Relapse rate in children with nephrotic syndrome during the SARS-CoV-2 pandemic,Pediatric Nephrology

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Relapse rate in children with nephrotic syndrome during the SARS-CoV-2 pandemic
Pediatric Nephrology ( IF 2.6 ) Pub Date : 2022-08-17 , DOI: 10.1007/s00467-022-05702-2
Benedetta Chiodini ₁ , Anita Sofia Bellotti ₂ , William Morello ₂ , Chiara Bulgaro ₂ , Ilaria Farella ₃ , Mario Giordano ₃ , Giovanni Montini ₂ , Khalid Ismaili ₁ , Karl Martin Wissing ₄

Affiliation

Background

Viral upper respiratory tract infections trigger nephrotic syndrome relapses. Few data exist on the impact of the SARS-CoV-2 pandemic on the risk of relapse in children with idiopathic nephrotic syndrome (INS).

Methods

In a Belgian and Italian cohort of children with INS, we performed a retrospective analysis on the number and duration of relapses observed in 3 different periods in 2020: first COVID period, February 15–May 31; second COVID period, June 1–September 14; third COVID period, September 15–December 31. Relapse rates were compared to those of the previous 5 years (PRECOVID period). For the years 2019 and 2020, all causes and INS relapse-related hospitalizations were recorded. Hospitalizations and deaths due to SARS-CoV-2 infection were also recorded. In the Belgian cohort, SARS-CoV-2 serologies were performed.

Results

A total of 218 patients were enrolled, and 29 (13.3%) were diagnosed with new-onset INS during the COVID period. Relapse rates per 1000 person-days were as follows: 3.2 in the PRECOVID period, 2.7 in the first COVID period, 3.3 in the second COVID period, and 3.0 in the third COVID period. The incidence rate ratio for the total COVID period was 0.9 (95%CI 0.76 to 1.06; P = 0.21) as compared to the PRECOVID period. During 2020, both the proportion of patients hospitalized for recurrence (14.2% vs. 7.6% in 2019; P = 0.03) and the rate of hospitalization for recurrence (IRR 1.97 (95%CI 1.35 to 2.88); P = 0.013) were higher compared to 2019. In December 2020, anti-SARS-CoV-2 antibodies were detected in 31% of the Belgian cohort. Patients with positive and negative SARS-CoV-2 serology did not differ significantly in relapse rate (2.4 versus 4.2 per 1000 person-days). The number of new INS cases remained similar between 2020, 2019, and 2018.

Conclusion

The first year of the SARS-CoV-2 pandemic did not significantly affect the relapse rate in children with INS. No serious infections were reported in this population of immunosuppressed patients.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

中文翻译：

SARS-CoV-2 大流行期间肾病综合征患儿的复发率

背景

病毒性上呼吸道感染引发肾病综合征复发。关于 SARS-CoV-2 大流行对特发性肾病综合征 (INS) 儿童复发风险影响的数据很少。

方法

在比利时和意大利 INS 儿童队列中，我们对 2020 年 3 个不同时期观察到的复发次数和持续时间进行了回顾性分析：第一个 COVID 时期，2 月 15 日至 5 月 31 日；第一个 COVID 时期，2 月 15 日至 5 月 31 日；第二个 COVID 时期，6 月 1 日至 9 月 14 日；第三个 COVID 时期，9 月 15 日至 12 月 31 日。将复发率与前 5 年（PRECOVID 时期）进行了比较。在 2019 年和 2020 年，记录了所有原因和 INS 复发相关的住院治疗。还记录了因 SARS-CoV-2 感染而住院和死亡的情况。在比利时队列中，进行了 SARS-CoV-2 血清学检查。

结果

共有 218 名患者入组，其中 29 名（13.3%）在 COVID 期间被诊断为新发 INS。每 1000 人日的复发率如下：PRECOVID 期间为 3.2，第一个 COVID 期间为 2.7，第二个 COVID 期间为 3.3，第三个 COVID 期间为 3.0。与 PRECOVID 时期相比，整个 COVID 时期的发病率比为 0.9（95%CI 0.76 至 1.06；P = 0.21）。2020 年期间，因复发住院的患者比例（14.2% vs. 2019 年为 7.6%；P = 0.03）和因复发住院率（IRR 1.97（95%CI 1.35 至 2.88）；P = 0.013）比 2019 年更高。2020 年 12 月，在 31% 的比利时队列中检测到抗 SARS-CoV-2 抗体。SARS-CoV-2 血清学阳性和阴性患者的复发率没有显着差异（每 1000 人天 2.4 对 4.2）。2020 年、2019 年和 2018 年期间，INS 的新案件数量保持相似。