A new study conducted in Egypt has revealed a concerning link between multisystem inflammatory syndrome in children (MIS-C) and acute kidney injury (AKI) in children who have contracted COVID-19. The retrospective study, carried out at Mansoura University, examined data from 138 children who developed MIS-C after a COVID-19 infection. Shockingly, over one-third of these children also suffered from AKI. The study aimed to shed light on the prevalence, severity, management, and outcomes of AKI in these cases, emphasizing the importance of early recognition and prompt treatment.
Previous studies have reported varying incidences of AKI in children with COVID-19, ranging from 5% to 44%. In this particular study, 37% of children with MIS-C-related COVID-19 developed AKI, accounting for 7.8% of all COVID-19 cases during the study period. These differing rates may be attributed to variations in AKI definitions, hospitalization rates, comorbid factors, and the prevalence of MIS-C cases.
The pathophysiology of AKI in MIS-C involves several factors, including dehydration, poor cardiac output, cytokine storm, and microvascular thrombosis. However, renal hypoperfusion emerged as a significant contributing factor in MIS-C patients. This led to longer stays in the intensive care unit (ICU), increased susceptibility to hypoxemia, and a higher need for inotropic support.
The most common presenting features in children with AKI and MIS-C were fever and dyspnea. More than 30% of patients with stage 3 AKI required oxygen therapy, while 50% needed invasive mechanical ventilation. This suggests a potential connection between hypoxemia and the development of AKI. Comorbidities, such as pulmonary, neurological, and malignancies, were also prevalent among AKI patients, highlighting the association between underlying health conditions and the severity of AKI.
Various laboratory parameters, including white blood cell count, erythrocyte sedimentation rate, serum ferritin, and creatinine levels on admission, were significantly higher in stage 3 AKI patients. Kidney biopsies performed in three cases revealed different pathological findings associated with COVID-19 infection, further emphasizing the complexity of renal involvement in MIS-C.
Hemodialysis was required for five stage 3 AKI patients, with an average duration of 9.9 days in the pediatric intensive care unit (PICU). Unfortunately, continuous renal replacement therapy (CRRT) was not available during the study period. Despite the severity of AKI, only two deaths (4.8%) were reported, underscoring the importance of early recognition and prompt management in improving overall outcomes. No residual renal impairment was observed at discharge for patients with previously normal kidney function.
The findings of this study provide crucial insights into the epidemiology and outcomes of AKI in Egyptian children with MIS-C-related COVID-19 infection. They highlight the need for vigilance in managing renal complications, avoiding nephrotoxic drugs, and initiating dialysis promptly in cases of MIS-C. Additionally, these findings open avenues for further research and advancements in clinical management strategies. The study was published in the peer-reviewed Italian Journal of Pediatrics.