Ağbaş Ayşe, Akkoç Gülşen, Kızılırmak Cevher, Çalışkan Dolu Nurcihan, Bayramoğlu Elvan, Elevli Murat
Department of Pediatric Nephrology, University of Health Sciences, Haseki Training and Research Hospital, İstanbul, Turkey; Department of Pediatric Nephrology, İstanbul University -Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey.
Department of Pediatric Infectious Diseases, University of Health Sciences, Haseki Training and Research Hospital, İstanbul, Turkey.
Turk Arch Pediatr. 2022 Sep;57(5):558-562. doi: 10.5152/TurkArchPediatr.2022.22012.
The kidney is the second most commonly affected organ by severe acute respiratory syndrome coronavirus-2, characterized by hematuria, proteinuria, and acute kidney injury. There are few studies describing renal involvement in pediatric cases.
This retrospective study evaluated the prevalence of hematuria, proteinuria, and acute kidney injury in severe acute respiratory syndrome coronavirus-2-positive pediatric cases (1-18 years old) who visited emergency department between March and November 2020. Patients with urinary tract infections were excluded. An age-specific upper limit of reference interval was used to define "elevated serum creatinine" (greater than upper limit of reference interval) and acute kidney injury (>1.5 times upper limit of reference interval).
A total of 228 patients were evaluated, median age was 12.7 years (interquartile range: 7.5; 16.1), and 51.3% were male. The prevalence of asymptomatic, mild, and moderate-to-severe disease was 12.7% (29/228), 77.2% (176/228), and 10.1% (23/228), respectively. The prevalence of hematuria, proteinuria, and elevated serum creatinine was 15.8% (36/228), 6% (14/228), and 3% (7/228), respectively. Kidney involvement (i.e., at least 1 of these findings) was 23.2% (53/228) and significantly higher in the moderate-to-severe disease (43.5%). None of the patients met the acute kidney injury criterion. In logistic regression analysis, female sex (odds ratio: 1.97, 95 CI%: 1.03; 3.70, P = .040) and fever (odds ratio: 2.28, 95% CI: 1.19; 4.36, P = .012) were independent predictors of kidney involvement. Three patients demonstrated a kidney presentation (macroscopic hematuria) on admission, and another patient was diagnosed with C3 glomerulonephritis during hospitalization.
Kidney involvement was found about in 1 quarter of children with coronavirus disease 2019. Awareness and recognition of kidney involvement and follow-up are important in the management.
肾脏是严重急性呼吸综合征冠状病毒2感染的第二常见受累器官，其特征为血尿、蛋白尿和急性肾损伤。描述儿科病例中肾脏受累情况的研究较少。
这项回顾性研究评估了2020年3月至11月期间前往急诊科就诊的严重急性呼吸综合征冠状病毒2阳性儿科病例（1至18岁）中血尿、蛋白尿和急性肾损伤的患病率。排除尿路感染患者。采用年龄特异性参考区间上限来定义“血清肌酐升高”（大于参考区间上限）和急性肾损伤（大于参考区间上限的1.5倍）。
共评估了228例患者，中位年龄为12.7岁（四分位间距：7.5；16.1），51.3%为男性。无症状、轻度和中重度疾病的患病率分别为12.7%（29/228）、77.2%（176/228）和10.1%（23/228）。血尿、蛋白尿和血清肌酐升高的患病率分别为15.8%（36/228）、6%（14/228）和3%（7/228）。肾脏受累（即至少有这些发现中的一项）为23.2%（53/228），在中重度疾病中显著更高（43.5%）。没有患者符合急性肾损伤标准。在逻辑回归分析中，女性（比值比：1.97，95%置信区间：1.03；3.70，P = 0.040）和发热（比值比：2.28，95%置信区间：1.19；4.36，P = 0.012）是肾脏受累的独立预测因素。3例患者入院时表现为肾脏症状（肉眼血尿），另1例患者在住院期间被诊断为C3肾小球肾炎。
在1/4的2019冠状病毒病儿童中发现有肾脏受累情况。在管理中，对肾脏受累的认识、识别及随访很重要。
