Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Jan;36(1):163-169.
doi: 10.1007/s00467-020-04715-z. Epub 2020 Aug 26.

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

Xiaowen Wang  1 , Xingfeng Chen  2 , Feng Tang  3 , Wanjun Luo  4 , Jian Fang  1 , Chang Qi  1 , Hua Sun  5 , Han Xiao  6 , Xuehua Peng  7 , Jianbo Shao  8   9   10
Affiliations
Case Reports

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

Xiaowen Wang et al. Pediatr Nephrol. 2021 Jan.

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.

Keywords: AKI; CKRT; COVID-19; Plasmapheresis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Correlation of serum creatinine and IL-6 levels in patients 1 (a), 2 (b), and 3 (c). Creatinine curve, solid line; IL-6 curve, dashed line. Plasma exchange and CKRT are labeled under the timeline in triangles and quadrilaterals, respectively. PE, plasma exchange; CVVHDF, continuous veno-venous hemodiafiltration
Fig. 2
Fig. 2
Axial chest CT of the three AKI patients with COVID-19. a Consolidation of the right lung of patient 1 is indicated by the arrow; b consolidation of bilateral lungs of patient 2 (arrows); c diffused patchy shadowing of bilateral lungs of patient 3
Fig. 3
Fig. 3
Axial abdomen CT scan images of patients 1 and 2 (a, b) showing enlarged kidneys (arrows). Hydronephrosis of the left kidney can be observed in patient 1 (star). The hydronephrosis disappeared before discharge
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. 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. Acute renal impairment in coronavirus-associated severe acute respiratory syndrome. Kidney Int. 2005;67:698–705. doi: 10.1111/j.1523-1755.2005.67130.x. - DOI - PMC - PubMed
    1. 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. 10.1101/2020.02.08.20021212%JmedRxiv
    1. Rismanbaf A, Zarei S. Liver and kidney injuries in COVID-19 and their effects on drug therapy; a letter to editor. Arch Acad Emerg Med. 2020;8:e17. - PMC - PubMed
    1. 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, 10.1101/2020.03.04.20031120medRxiv - PubMed
    1. 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. 10.1016/j.kint.2020.03.005 - PMC - PubMed

Publication types