Be aware of acute kidney injury in critically ill children with COVID-19
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ORIGINAL ARTICLE
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 2,7,8 Received: 23 April 2020 / Revised: 19 June 2020 / Accepted: 13 July 2020 # IPNA 2020
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 COVID-19 . AKI . Plasmapheresis . CKRT
Xiaowen Wang and Xingfeng Chen contributed equally to this work. * Jianbo Shao [email protected]
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Department of Nephrology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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Department of Nephrology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430000, China
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Institute of Maternal and Child Health, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430000, China
2
Intensive Care Unit, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430000, China
7
Medical Imaging Center, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical
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