nach oben

Erschienen in:

26.08.2020 | COVID-19 | Original Article Zur Zeit gratis

Be aware of acute kidney injury in critically ill children with COVID-19

verfasst von: Xiaowen Wang, Xingfeng Chen, Feng Tang, Wanjun Luo, Jian Fang, Chang Qi, Hua Sun, Han Xiao, Xuehua Peng, Jianbo Shao

Erschienen in: Pediatric Nephrology | Ausgabe 1/2021

Einloggen, um Zugang zu erhalten

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Chu KH, Tsang WK, Tang CS, Lam MF, Lai FM, To KF, Fung KS, Tang HL, Yan WW, Chan HW, Lai TS, Tong KL, Lai KN (2005) Acute renal impairment in coronavirus-associated severe acute respiratory syndrome. Kidney Int 67:698–705. https://doi.org/10.1111/j.1523-1755.2005.67130.xCrossRefPubMedPubMedCentral

Li Z, Wu M, Yao J, Guo J, Liao X, Song S, Li J, Duan G, Zhou Y, Wu X, Zhou Z, Wang T, Hu M, Chen X, Fu Y, Lei C, Dong H, Xu C, Hu Y, Han M, Zhou Y, Jia H, Chen X, Yan J (2020) Caution on kidney dysfunctions of COVID-19 patients. medRxiv. https://doi.org/10.1101/2020.02.08.20021212%JmedRxiv

Rismanbaf A, Zarei S (2020) Liver and kidney injuries in COVID-19 and their effects on drug therapy; a letter to editor. Arch Acad Emerg Med 8:e17PubMedPubMedCentral

Diao B, Wang C, Wang R, Feng Z, Tan Y, Wang H, Wang C, Liu L, Liu Y, Liu Y, Wang G, Yuan Z, Ren L, Wu Y, Chen Y (2020) Human kidney is a target for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. medRxiv, https://doi.org/10.1101/2020.03.04.20031120medRxiv

Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, Li J, Yao Y, Ge S, Xu G (2020) Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. https://doi.org/10.1016/j.kint.2020.03.005

(2020) The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi 41:145–151. https://doi.org/10.3760/cma.j.issn.0254-6450.2020.02.003

Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, Zhang W, Wang Y, Bao S, Li Y, Wu C, Liu H, Liu D, Shao J, Peng X, Yang Y, Liu Z, Xiang Y, Zhang F, Silva RM, Pinkerton KE, Shen K, Xiao H, Xu S, Wong GWK (2020) SARS-CoV-2 infection in children. N Engl J Med. https://doi.org/10.1056/NEJMc2005073

Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL (2017) Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med 376:11–20. https://doi.org/10.1056/NEJMoa1611391CrossRefPubMed

Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, Herzog CA, Joannidis M, Kribben A, Levey AS (2012) Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2:1–138CrossRef

10.

Lameire N, Van Biesen W, Vanholder R (2017) Epidemiology of acute kidney injury in children worldwide, including developing countries. Pediatr Nephrol 32:1301–1314. https://doi.org/10.1007/s00467-016-3433-2CrossRefPubMed

11.

Perico L, Benigni A, Remuzzi G (2020) Should COVID-19 concern nephrologists? Why and to what extent? The emerging impasse of angiotensin blockade. Nephron 144:213–221. https://doi.org/10.1159/000507305CrossRef

12.

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu T, Wang Y, Pan S, Zou X, Yuan S, Shang Y (2020) Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. https://doi.org/10.1016/s2213-2600(20)30079-5

13.

Yang XH, Sun RH, Chen DC (2020) Diagnosis and treatment of COVID-19: acute kidney injury cannot be ignored. Zhonghua Yi Xue Za Zhi 100:E017. https://doi.org/10.3760/cma.j.cn112137-20200229-00520CrossRef

14.

Sutherland SM, Kwiatkowski DM (2017) Acute kidney injury in children. Adv Chronic Kidney Dis 24:380–387. https://doi.org/10.1053/j.ackd.2017.09.007CrossRefPubMed

15.

Xu X, Nie S, Zhang A, Mao J, Liu HP, Xia H, Xu H, Liu Z, Feng S, Zhou W, Liu X, Yang Y, Tao Y, Feng Y, Chen C, Wang M, Zha Y, Feng JH, Li Q, Ge S, Chen J, He Y, Teng S, Hao C, Liu BC, Tang Y, He W, He P, Hou FF (2018) Acute kidney injury among hospitalized children in China. Clin J Am Soc Nephrol 13:1791–1800. https://doi.org/10.2215/CJN.00800118CrossRefPubMedPubMedCentral

16.

Benoit SW, Devarajan P (2018) Acute kidney injury: emerging pharmacotherapies in current clinical trials. Pediatr Nephrol 33:779–787. https://doi.org/10.1007/s00467-017-3695-3CrossRefPubMed

17.

Ciccia E, Devarajan P (2017) Pediatric acute kidney injury: prevalence, impact and management challenges. Int J Nephrol Renovasc Dis 10:77–84. https://doi.org/10.2147/IJNRD.S103785CrossRefPubMedPubMedCentral

18.

Xu X, Nie S, Zhang A, Jianhua M, Liu HP, Xia H, Xu H, Liu Z, Feng S, Zhou W, Liu X, Yang Y, Tao Y, Feng Y, Chen C, Wang M, Zha Y, Feng JH, Li Q, Ge S, Chen J, He Y, Teng S, Hao C, Liu BC, Tang Y, Wang LJ, Qi JL, He W, He P, Liu Y, Hou FF (2018) A new criterion for pediatric AKI based on the reference change value of serum creatinine. J Am Soc Nephrol 29:2432–2442. https://doi.org/10.1681/ASN.2018010090CrossRefPubMedPubMedCentral

19.

Deng YY, Zheng Y, Cai GY, Chen XM, Hong Q (2020) Single-cell RNA sequencing data suggest a role for angiotensin-converting enzyme 2 in kidney impairment in patients infected with 2019-nCoV. Chin Med J. https://doi.org/10.1097/cm9.0000000000000783

20.

Chen Y, Guo Y, Pan Y, Zhao ZJ (2020) Structure analysis of the receptor binding of 2019-nCoV. Biochem Biophys Res Commun. https://doi.org/10.1016/j.bbrc.2020.02.071

21.

Qi F, Qian S, Zhang S, Zhang Z (2020) Single cell RNA sequencing of 13 human tissues identify cell types and receptors of human coronaviruses. Biochem Biophys Res Commun. https://doi.org/10.1016/j.bbrc.2020.03.044

22.

Shang J, Ye G, Shi K, Wan Y, Luo C, Aihara H, Geng Q, Auerbach A, Li F (2020) Structural basis of receptor recognition by SARS-CoV-2. Nature. https://doi.org/10.1038/s41586-020-2179-y

23.

Tveito K (2020) Cytokine storms in COVID-19 cases? Tidsskr Nor Laegeforen 140. https://doi.org/10.4045/tidsskr.20.0239

24.

Pedersen SF, Ho YC (2020) SARS-CoV-2: a storm is raging. J Clin Invest. https://doi.org/10.1172/jci137647

25.

Ronco C, Reis T (2020) Kidney involvement in COVID-19 and rationale for extracorporeal therapies. Nat Rev Nephrol. https://doi.org/10.1038/s41581-020-0284-7

26.

Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, Huang H, Zhang L, Zhou X, Du C, Zhang Y, Song J, Wang S, Chao Y, Yang Z, Xu J, Zhou X, Chen D, Xiong W, Xu L, Zhou F, Jiang J, Bai C, Zheng J, Song Y (2020) Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. https://doi.org/10.1001/jamainternmed.2020.0994

27.

Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, Baxter-Stoltzfus A, Laurence J (2020) Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res 220:1–13. https://doi.org/10.1016/j.trsl.2020.04.007CrossRefPubMedPubMedCentral

28.

Su H, Yang M, Wan C, Yi L-X, Tang F, Zhu H-Y, Yi F, Yang H-C, Fogo AB, Nie X, Zhang C (2020) Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. https://doi.org/10.1016/j.kint.2020.04.003

29.

Mulay SR, Holderied A, Kumar SV, Anders HJ (2016) Targeting inflammation in so-called acute kidney injury. Semin Nephrol 36:17–30. https://doi.org/10.1016/j.semnephrol.2016.01.006CrossRefPubMed

30.

McCullough JW, Renner B, Thurman JM (2013) The role of the complement system in acute kidney injury. Semin Nephrol 33:543–556. https://doi.org/10.1016/j.semnephrol.2013.08.005CrossRefPubMed

31.

Zilberman-Itskovich S, Abu-Hamad R, Stark M, Efrati S (2019) Effect of anti-C5 antibody on recuperation from ischemia/reperfusion-induced acute kidney injury. Ren Fail 41:967–975. https://doi.org/10.1080/0886022x.2019.1677248CrossRefPubMedPubMedCentral

32.

Ma J, Xia P, Zhou Y, Liu Z, Zhou X, Wang J, Li T, Yan X, Chen L, Zhang S, Qin Y, Li X (2020) Potential effect of blood purification therapy in reducing cytokine storm as a late complication of severe COVID-19. Clin Immunol 108408. https://doi.org/10.1016/j.clim.2020.108408

33.

Fayad AI, Buamscha DG, Ciapponi A (2016) Intensity of continuous renal replacement therapy for acute kidney injury. Cochrane Database Syst Rev 10:CD010613. https://doi.org/10.1002/14651858.CD010613.pub2CrossRefPubMed

34.

Zhang J, Tian J, Sun H, Digvijay K, Neri M, Bhargava V, Yin Y, Ronco C (2018) How does continuous renal replacement therapy affect septic acute kidney injury? Blood Purif 46:326–331. https://doi.org/10.1159/000492026CrossRefPubMed

Titel: Be aware of acute kidney injury in critically ill children with COVID-19
verfasst von: Xiaowen Wang
Xingfeng Chen
Feng Tang
Wanjun Luo
Jian Fang
Chang Qi
Hua Sun
Han Xiao
Xuehua Peng
Jianbo Shao
Publikationsdatum: 26.08.2020
Verlag: Springer Berlin Heidelberg
Schlagwort: COVID-19
Erschienen in: Pediatric Nephrology / Ausgabe 1/2021
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-020-04715-z

Neu im Fachgebiet Pädiatrie

ADHS-Medikation erhöht das kardiovaskuläre Risiko

16.05.2024 Herzinsuffizienz Nachrichten

Erwachsene, die Medikamente gegen das Aufmerksamkeitsdefizit-Hyperaktivitätssyndrom einnehmen, laufen offenbar erhöhte Gefahr, an Herzschwäche zu erkranken oder einen Schlaganfall zu erleiden. Es scheint eine Dosis-Wirkungs-Beziehung zu bestehen.

Erstmanifestation eines Diabetes-Typ-1 bei Kindern: Ein Notfall!

16.05.2024 DDG-Jahrestagung 2024 Kongressbericht

Manifestiert sich ein Typ-1-Diabetes bei Kindern, ist das ein Notfall – ebenso wie eine diabetische Ketoazidose. Die Grundsäulen der Therapie bestehen aus Rehydratation, Insulin und Kaliumgabe. Insulin ist das Medikament der Wahl zur Behandlung der Ketoazidose.

Frühe Hypertonie erhöht späteres kardiovaskuläres Risiko

16.05.2024 Arterielle Hypertonie in der Pädiatrie Nachrichten

Wie wichtig es ist, pädiatrische Patienten auf Bluthochdruck zu screenen, zeigt eine kanadische Studie: Hypertone Druckwerte in Kindheit und Jugend steigern das Risiko für spätere kardiovaskuläre Komplikationen.

Betalaktam-Allergie: praxisnahes Vorgehen beim Delabeling

16.05.2024 Pädiatrische Allergologie Nachrichten

Die große Mehrheit der vermeintlichen Penicillinallergien sind keine. Da das „Etikett“ Betalaktam-Allergie oft schon in der Kindheit erworben wird, kann ein frühzeitiges Delabeling lebenslange Vorteile bringen. Ein Team von Pädiaterinnen und Pädiatern aus Kanada stellt vor, wie sie dabei vorgehen.

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Be aware of acute kidney injury in critically ill children with COVID-19

Abstract

Background

Methods

Results

Conclusions

Neu im Fachgebiet Pädiatrie

ADHS-Medikation erhöht das kardiovaskuläre Risiko

Erstmanifestation eines Diabetes-Typ-1 bei Kindern: Ein Notfall!

Frühe Hypertonie erhöht späteres kardiovaskuläres Risiko

Betalaktam-Allergie: praxisnahes Vorgehen beim Delabeling

Update Pädiatrie

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

Background

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2021

Prediction of kidney failure in children with chronic kidney disease and obstructive uropathy

Membranous nephropathy: diagnosis, treatment, and monitoring in the post-PLA2R era

Effects of COVID-19 pandemic on pediatric kidney transplant in the United States

Pre-pregnancy obesity and risk of congenital abnormalities of the kidney and urinary tract (CAKUT)—systematic review, meta-analysis and ecological study

Mitochondrial DNA mutations in renal disease: an overview

What does acute kidney injury and dark red-brown urine that appear after bone marrow transplantation tell us: Answers

Neu im Fachgebiet Pädiatrie

ADHS-Medikation erhöht das kardiovaskuläre Risiko

Erstmanifestation eines Diabetes-Typ-1 bei Kindern: Ein Notfall!

Frühe Hypertonie erhöht späteres kardiovaskuläres Risiko

Betalaktam-Allergie: praxisnahes Vorgehen beim Delabeling

Update Pädiatrie