AKI in Children with SARS-CoV-2 Infection with and without MIS-C

Researchers, led by Manpreet K. Grewal, MD, conducted a retrospective chart review to examine the prevalence and factors associated with the risk of acute kidney injury (AKI) in pediatric patients with SARS-CoV-2 infection and multisystem inflammatory syndrome in children (MIS-C).

The review included 113 patients with SARS-CoV-2 infection with and without MIS-C who were admitted at Children’s Hospital of Michigan from March to August 2021. The final analysis included 92 patients. Of those, 24% (n=22) developed AKI, with eight of the 22 (36%) developing AKI stage 3. The prevalence of AKI was substantially higher in patients with MIS-C (54%; 15/28) than in those with acute SARS-CoV-2 infection (11%; 7/64), P<.001.

Overall, compared with patients without AKI, those with AKI were older (11 vs 6.5 years; P=.007), were Black (86% vs 58%; P=.0028), had a diagnosis of MIS-C (68% vs 19%; P<.001), required admission to the intensive care unit (91% vs 20%; P<.001), had cardiac dysfunction (63% vs 16%; P<.001), required inotropic support (59% vs 6%; P<.001) and had a greater elevation in inflammatory markers. In multivariable analysis, the most significant predictors for AKI were the requirement of inotropes (odds ratio [OR], 22.8; P<.001), Black race (OR, 8.8; P=.023), and MIS-C diagnosis (OR, 5.3; P=.013). All of the patients had recovery of kidney function, and none required kidney replacement therapy.

In conclusion, the authors said, “Children with acute SARS-CoV-2 infection and MIS-C are at risk for AKI, with the risk being significantly greater with MIS-2. The pathogenesis of AKI in acute SARS-CoV-2 infection appears to be a combination of both renal hypoperfusion and direct renal parenchymal damage whereas in MIS-C, the renal injury appears to be predominantly prerenal from cardiac dysfunction and capillary leak from a hyperinflammatory state. These factors should be considered by clinicians caring for these children with a special focus on renal protective strategies to aid in recovery and prevent additional injury to this high-risk subgroup.”