Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Institute of Child Health, University College London, London, UK.
Arch Dis Child. 2022 Mar;107(3):e21. doi: 10.1136/archdischild-2021-322866. Epub 2021 Dec 3.
Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a rare complication of SARS-CoV-2 associated with single or multiorgan dysfunction.
We aimed to evaluate the incidence of acute kidney injury (AKI) and risk factors for kidney dysfunction in PIMS-TS, with reporting of 6-month renal follow-up data. We also evaluated renal involvement between first and second waves of the SARS-CoV-2 pandemic in the UK, the latter attributed to the Alpha variant.
A single-centre observational study was conducted through patient chart analysis.
Data were collected from patients admitted to Great Ormond Street Hospital, London, UK, between April 2020 and March 2021.
110 patients <18 years of age.
AKI during hospitalisation. AKI classification was based on upper limit of reference interval (ULRI) serum creatinine (sCr) values.
AKI occurred in 33 (30%) patients. Hypotension/hypoperfusion was associated with almost all cases. In univariate analysis, the AKI cohort had higher peak levels of triglycerides (OR, 1.27 (95% CI, 1.05 to 1.6) per 1 mmol/L increase) and C reactive protein (OR, 1.06 (95% CI, 1.02 to 1.12) per 10 mg/L increase), with higher requirement for mechanical ventilation (OR, 3.8 (95% CI, 1.46 to 10.4)) and inotropic support (OR, 15.4 (95% CI, 3.02 to 2.81)). In multivariate analysis, triglycerides were independently associated with AKI stages 2-3 (adjusted OR, 1.26 (95% CI, 1.04 to 1.6)). At follow-up, none had macroalbuminuria and all had sCr values <ULRI. No discrepancy in renal involvement between pandemic waves was found.
Despite a high incidence of AKI in PIMS-TS, renal recovery occurs rapidly with current therapies, and no patients developed chronic kidney disease.
与 SARS-CoV-2 相关的儿童炎症性多系统综合征（PIMS-TS）是 SARS-CoV-2 相关的一种罕见并发症，伴有单一或多器官功能障碍。
我们旨在评估 PIMS-TS 中急性肾损伤（AKI）的发生率和肾功能障碍的危险因素，并报告 6 个月的肾脏随访数据。我们还评估了英国 SARS-CoV-2 大流行第一波和第二波之间的肾脏受累情况，后者归因于 Alpha 变体。
通过患者图表分析进行单中心观察性研究。
数据来自于英国伦敦大奥蒙德街医院收治的患者。
110 名年龄<18 岁的患者。
住院期间 AKI。AKI 分类基于参考区间上限（ULRI）血清肌酐（sCr）值。
33 名（30%）患者发生 AKI。低血压/低灌注与几乎所有病例有关。在单变量分析中，AKI 组的甘油三酯峰值水平更高（OR，1.27（95%CI，1.05 至 1.6）/每增加 1mmol/L）和 C 反应蛋白（OR，1.06（95%CI，1.02 至 1.12）/每增加 10mg/L），需要机械通气（OR，3.8（95%CI，1.46 至 10.4））和正性肌力支持（OR，15.4（95%CI，3.02 至 2.81））的可能性更高。多变量分析显示，甘油三酯与 AKI 2-3 期独立相关（调整后的 OR，1.26（95%CI，1.04 至 1.6））。在随访时，没有患者出现大量白蛋白尿，所有患者的 sCr 值均<ULRI。在大流行波之间未发现肾脏受累的差异。
尽管 PIMS-TS 中 AKI 的发生率较高，但目前的治疗方法可迅速恢复肾功能，且无患者发生慢性肾脏病。
