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Acute kidney injury in children with moderate-severe COVID-19 and multisystem inflammatory syndrome in children: a referral center experience

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Abstract

Background

Data on the characteristics of acute kidney injury (AKI) in pediatric COVID-19 and MIS-C are limited. We aimed to define the frequency, associated factors and early outcome of AKI in moderate, severe or critical COVID-19 and MIS-C; and to present a tertiary referral center experience from Türkiye.

Methods

Hospitalized patients ≤ 18 years of age with confirmed COVID-19 or MIS-C at İhsan Doğramacı Children's Hospital, Hacettepe University, between March 2020—December 2021 were enrolled. The characteristics of AKI in the COVID-19 group were investigated in moderate, severe and critically ill patients; patients with mild COVID-19 were excluded.

Results

The median (Q1-Q3) age in the COVID-19 (n = 66) and MIS-C (n = 111) groups was 10.7 years (3.9–15.2) and 8.7 years (4.5–12.7), respectively. The frequency of AKI was 22.7% (15/66) in COVID-19 and 15.3% (17/111) in MIS-C; all MIS-C patients with AKI and 73.3% (11/15) of COVID-19 patients with AKI had AKI at the time of admission. Multivariate analyses revealed need for vasoactive/inotropic agents [Odds ratio (OR) 19.233, p = 0.002] and presence of vomiting and/or diarrhea (OR 4.465, p = 0.036) as independent risk factors of AKI in COVID-19 patients; and need for vasoactive/inotropic agents (OR 22.542, p = 0.020), procalcitonin and ferritin levels as independent risk factors of AKI in the MIS-C group. Age was correlated with lymphocyte count (r = -0.513, p < 0.001) and troponin level (r = 0.518, p < 0.001) in MIS-C patients. Length of hospital stay was significantly longer in both groups with AKI, compared to those without AKI. Mortality was 9.1% in the COVID-19 group; and was associated with AKI (p = 0.021). There was no mortality in MIS-C patients. AKI recovery at discharge was 63.6% in COVID-19 survivors and 100% in MIS-C patients.

Conclusions

Independent risk factors for AKI were need for vasoactive/inotropic agents and vomiting/diarrhea in moderate, severe or critical COVID-19 patients; and need for vasoactive/inotropic agents and severe inflammation in MIS-C patients. Our findings suggest that inflammation and cardiac dysfunction are associated with AKI in MIS-C patients; and the association with age in this group merits further studies in larger groups. Early outcome is favorable; long-term follow-up for kidney functions is needed.

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Author notes

  1. Tugba Tastemel Ozturk and Ali Düzova contributed equally to this work.

Authors and Affiliations

  1. Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye

    Tugba Tastemel Ozturk, Ali Düzova, Demet Baltu, Eda Didem Kurt-Sukur, Bora Gulhan, Fatih Ozaltin & Rezan Topaloglu

  2. Division of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Türkiye

    Pembe Derin Oygar, Sibel Lacinel Gurlevik, Yasemin Ozsurekci & Ali Bulent Cengiz

  3. Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye

    Pelin Ozcilingir Hakverdi

  4. Division of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye

    Hayrettin Hakan Aykan & Ilker Ertugrul

  5. Life Support Center, Hacettepe University, Ankara, Türkiye

    Hayrettin Hakan Aykan & Selman Kesici

  6. Division of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye

    Seza Ozen

  7. Division of Pediatric Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Türkiye

    Selman Kesici

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  1. Tugba Tastemel Ozturk
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Contributions

Study concept and design: AD, TTO, ABC, YO.

Data acquisition: TTO, PDO, DB, POH, SLG.

Data analysis/interpretation: AD, TTO; all authors reviewed the results.

The first draft of the manuscript was written by TTO and AD; all authors commented on previous versions of the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Ali Düzova.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethics approval

The study protocol was approved by the Hacettepe University Clinical Research Ethics Committee (KA-21092). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Tastemel Ozturk, T., Düzova, A., Oygar, P.D. et al. Acute kidney injury in children with moderate-severe COVID-19 and multisystem inflammatory syndrome in children: a referral center experience. Pediatr Nephrol 39, 867–877 (2024). https://doi.org/10.1007/s00467-023-06125-3

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