Department of Nephrology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430000, China.
Intensive Care Unit, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430000, China.
Pediatr Nephrol. 2021 Jan;36(1):163-169. doi: 10.1007/s00467-020-04715-z. Epub 2020 Aug 26.
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.
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.
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.
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.
急性肾损伤（AKI）是 COVID-19 重症成年患者的常见并发症。然而，目前尚无研究调查 COVID-19 儿童的肾脏损伤。我们调查了 COVID-19 大流行期间武汉儿童医院儿科患者 AKI 的发病率和治疗方法，并讨论了与 SARS-CoV-2 感染相关的 AKI 的可能机制。
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 COVID-19 爆发期间武汉儿童医院确诊的 COVID-19 儿科病例的肾脏受累情况进行了回顾性观察研究。描述了临床表现、临床过程、实验室发现和医疗干预措施。
在 238 例确诊的 COVID-19 病例中，只有 3 例病情危重，需要入住重症监护病房（ICU）。所有 3 例均发生 AKI，但在 ICU 外的非危重病患者中未发现 AKI。3 例 AKI 患者均有前驱胃肠道症状。这些 AKI 患者的白细胞介素 6（IL-6）水平和补体激活显著升高。3 例 AKI 患者接受了血浆置换（PE）和连续肾脏替代治疗（CKRT），其中 1 例完全康复，1 例部分康复，1 例因病情危重死亡。
COVID-19 重症儿童可能会发生 AKI，尤其是在出现前驱胃肠道症状后。炎症风暴和补体介导的损伤可能是 COVID-19 儿童 AKI 发展的基础。我们的研究支持在管理 AKI 危重病患者时植入 PE 和 CKRT。
