Shah Siddharth A, Carter Helen P
Department of Pediatrics, University of Louisville, Louisville, KY, United States.
Bowling Green Internal Medicine and Pediatric Associates, Bowling Green, KY, United States.
Front Pediatr. 2020 Aug 20;8:471. doi: 10.3389/fped.2020.00471. eCollection 2020.
The COVID-19 outbreak has become a worldwide public health emergency. The renal histopathological features of acute tubular necrosis or thrombotic microangiopathy have been previously reported in adults with severe COVID-19 infections. In children, the renal manifestations associated with COVID-19 disease are not widely reported. Here we describe a case report of a child with new-onset nephrotic syndrome associated with COVID-19 infection. An 8-year-old boy with no previous significant medical history presented with bilateral eyelid and facial swelling soon after his parents were diagnosed with COVID-19 infection. He had diarrhea but no fever or shortness of breath. At 1 week after the onset of swelling, the boy tested positive for the COVID-19 virus. Based on clinical findings of significant proteinuria (urine protein and creatinine ratio of 11.4), hypoalbuminemia (serum albumin of 2 g/dl), and hypercholesterolemia (total cholesterol of 384 mg/dl), he was diagnosed with nephrotic syndrome. He responded well to standard-dose prednisone treatment for nephrotic syndrome. At 1 week after starting the prednisone treatment, he went into clinical remission. Lymphopenia continued to be present for 4 weeks after the onset of symptoms. There were no complications related to clot formation or secondary infections with this presentation. COVID-19 can be associated with new-onset nephrotic syndrome in children. The patient responded well to the standard-dose prednisone treatment that is typically used for new-onset nephrotic syndrome. We describe the unique presentation of COVID-19 in a child as new-onset nephrotic syndrome. We offer insight on the success of standard treatment of nephrotic syndrome with COVID-19.
新型冠状病毒肺炎（COVID-19）疫情已成为全球突发公共卫生事件。此前已有报道称，患有严重COVID-19感染的成人出现急性肾小管坏死或血栓性微血管病的肾脏组织病理学特征。在儿童中，与COVID-19疾病相关的肾脏表现报道较少。在此，我们报告一例与COVID-19感染相关的新发肾病综合征患儿病例。一名既往无重大病史的8岁男孩，在其父母被诊断为COVID-19感染后不久，出现双侧眼睑和面部肿胀。他有腹泻症状，但无发热或呼吸急促。肿胀发作1周后，该男孩COVID-19病毒检测呈阳性。根据大量蛋白尿（尿蛋白与肌酐比值为11.4）、低白蛋白血症（血清白蛋白为2 g/dl）和高胆固醇血症（总胆固醇为384 mg/dl）的临床检查结果，他被诊断为肾病综合征。他对肾病综合征的标准剂量泼尼松治疗反应良好。开始泼尼松治疗1周后，他进入临床缓解期。症状出现后4周淋巴细胞减少持续存在。此次发病未出现与血栓形成或继发感染相关的并发症。COVID-19可与儿童新发肾病综合征相关。该患者对通常用于新发肾病综合征的标准剂量泼尼松治疗反应良好。我们将COVID-19在儿童中的独特表现描述为新发肾病综合征。我们提供了关于COVID-19合并肾病综合征标准治疗成功的见解。
