Pediatric Nephrology Center of Excellence, Department of Pediatrics, King Abdulaziz University, PO Box: 80215, 21589, Jeddah, Kingdom of Saudi Arabia.
King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
BMC Nephrol. 2021 May 31;22(1):202. doi: 10.1186/s12882-021-02389-9.
Acute kidney injury (AKI) is a complication of coronavirus disease 2019 (COVID-19). The reported incidence of AKI, however, varies among studies. We aimed to evaluate the incidence of AKI and its association with mortality and morbidity in children infected with severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) who required hospital admission.
This was a multicenter retrospective cohort study from three tertiary centers, which included children with confirmed COVID-19. All children were evaluated for AKI using the Kidney Disease Improving Global Outcomes (KDIGO) definition and staging.
Of 89 children included, 19 (21 %) developed AKI (52.6 % stage I). A high renal angina index score was correlated with severity of AKI. Also, multisystem inflammatory syndrome in children (MIS-C) was increased in children with AKI compared to those with normal kidney function (15 % vs. 1.5 %). Patients with AKI had significantly more pediatric intensive care admissions (PICU) (32 % vs. 2.8 %, p < 0.001) and mortality (42 % vs. 0 %, p < 0.001). However, AKI was not associated with prolonged hospitalization (58 % vs. 40 %, p = 0.163) or development of MIS-C (10.5 % vs. 1.4 %, p = 0.051). No patient in the AKI group required renal replacement therapy. Residual renal impairment at discharge occurred in 9 % of patients. This was significantly influenced by the presence of comorbidities, hypotension, hypoxia, heart failure, acute respiratory distress, hypernatremia, abnormal liver profile, high C-reactive protein, and positive blood culture.
AKI occurred in one-fifth of children with SARS-CoV-2 infection requiring hospital admission, with one-third of those requiring PICU. AKI was associated with increased morbidity and mortality, and residual renal impairment at time of discharge.
急性肾损伤（AKI）是 2019 年冠状病毒病（COVID-19）的一种并发症。然而，不同研究报道的 AKI 发生率有所不同。我们旨在评估因严重急性呼吸窘迫综合征冠状病毒 2（SARS-CoV-2）感染而需要住院的儿童中 AKI 的发生率及其与死亡率和发病率的关系。
这是一项来自三个三级中心的多中心回顾性队列研究，包括确诊 COVID-19 的儿童。所有儿童均采用肾脏病改善全球结局（KDIGO）定义和分期评估 AKI。
在 89 名儿童中，有 19 名（21%）发生 AKI（52.6%为 I 期）。高肾绞痛指数评分与 AKI 的严重程度相关。此外，与肾功能正常的儿童相比，AKI 患儿中多系统炎症综合征在儿童中的发生率更高（15%比 1.5%）。AKI 患者有显著更多的儿科重症监护病房（PICU）入住（32%比 2.8%，p<0.001）和死亡率（42%比 0%，p<0.001）。然而，AKI 与住院时间延长（58%比 40%，p=0.163）或多系统炎症综合征在儿童中的发生（10.5%比 1.4%，p=0.051）无关。AKI 组无患者需要肾脏替代治疗。出院时仍有 9%的患者存在肾功能损害，这与合并症、低血压、缺氧、心力衰竭、急性呼吸窘迫、高钠血症、肝功能异常、高 C 反应蛋白和血培养阳性显著相关。
在因 SARS-CoV-2 感染而需要住院的儿童中，有五分之一发生 AKI，其中三分之一需要入住 PICU。AKI 与发病率和死亡率增加以及出院时仍存在肾功能损害有关。
