Renal involvement in pediatric patients with COVID-19: an up-to-date

Background: In pediatric patients, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has been mostly associated with mild symptoms. However, as in adults, renal involvement has been reported in children and adolescents with Coronavirus Disease 2019 (COVID-19). Objective: This review aimed to report data about renal involvement in pediatric COVID-9. The focuses were on the pathophysiology of acute kidney injury in Pediatric Inflammatory Multisystem Syndrome Temporally Associated (PIMS-TS) with SARS-CoV-2 and the possible impact of SARS-CoV-2 infection upon kidney function, as well as data concerning patients with previous kidney diseases, including Nephrotic Syndrome and Chronic Renal Disease. The implications for COVID-19 outcome in pediatric patients were also discussed. Methods: This integrative review searched for articles on renal involvement in pediatric COVID-19 patients. The databases evaluated were PubMed and Scopus. Results: The emergence of PIMS-TS with SARS-CoV-2 has shown that pediatric patients are at risk of severe COVID-19, with multi-organ involvement and dysfunction. In addition to intense inflammation, several systems are affected in this syndrome, collectively creating a combination of factors that results in acute kidney injury. Several studies have proposed that kidney cells, including the podocytes, might be at risk of direct infection by SARS-CoV-2, as high levels of ACE2, the virus receptor, are expressed on the membrane of such cells. Some cases of glomerular diseases triggered by SARS-CoV-2 infection and relapses of previous renal diseases have been reported. Conclusion: Further studies are necessary to establish risk factors for renal involvement in pediatric COVID-19 and to predict disease outcome.

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Circular RNAs as Novel Diagnostic Biomarkers and Therapeutic Targets in Kidney Disease

Frontiers in Medicine ◽

10.3389/fmed.2021.714958 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jianwen Yu ◽

Danli Xie ◽

Naya Huang ◽

Qin Zhou

Keyword(s):

Kidney Disease ◽

Kidney Diseases ◽

Expression Patterns ◽

Therapeutic Targets ◽

Kidney Injury ◽

Renal Diseases ◽

Circular Rnas ◽

Specific Expression ◽

Glomerular Diseases ◽

Diagnosis And Prognosis

Circular RNAs (circRNAs) are a novel type of non-coding RNAs that have aroused growing attention in this decade. They are widely expressed in eukaryotes and generally have high stability owing to their special closed-loop structure. Many circRNAs are abundant, evolutionarily conserved, and exhibit cell-type-specific and tissue-specific expression patterns. Mounting evidence suggests that circRNAs have regulatory potency for gene expression by acting as microRNA sponges, interacting with proteins, regulating transcription, or directly undergoing translation. Dysregulated expression of circRNAs were found in many pathological conditions and contribute to the pathogenesis and progression of various disorders, including renal diseases. Recent studies have revealed that circRNAs may serve as novel reliable biomarkers for the diagnosis and prognosis prediction of multiple kidney diseases, such as renal cell carcinoma (RCC), acute kidney injury (AKI), diabetic kidney disease (DKD), and other glomerular diseases. Furthermore, circRNAs expressed by intrinsic kidney cells are shown to play a substantial role in kidney injury, mostly reported in DKD and RCC. Herein, we review the biogenesis and biological functions of circRNAs, and summarize their roles as promising biomarkers and therapeutic targets in common kidney diseases.

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IL-20 in Acute Kidney Injury: Role in Pathogenesis and Potential as a Therapeutic Target

International Journal of Molecular Sciences ◽

10.3390/ijms21031009 ◽

2020 ◽

Vol 21 (3) ◽

pp. 1009

Author(s):

Tian-Yu Lin ◽

Yu-Hsiang Hsu

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Risk Factor ◽

Renal Fibrosis ◽

Inflammatory Mediator ◽

Kidney Diseases ◽

Kidney Injury ◽

Renal Diseases ◽

Pro Inflammatory Cytokines

Acute kidney injury (AKI) causes over 1 million deaths worldwide every year. AKI is now recognized as a major risk factor in the development and progression of chronic kidney disease (CKD). Diabetes is the main cause of CKD as well. Renal fibrosis and inflammation are hallmarks in kidney diseases. Various cytokines contribute to the progression of renal diseases; thus, many drugs that specifically block cytokine function are designed for disease amelioration. Numerous studies showed IL-20 functions as a pro-inflammatory mediator to regulate cytokine expression in several inflammation-mediated diseases. In this review, we will outline the effects of pro-inflammatory cytokines in the pathogenesis of AKI and CKD. We also discuss the role of IL-20 in kidney diseases and provide a potential therapeutic approach of IL-20 blockade for treating renal diseases.

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Development and Performance of Electronic Acute Kidney Injury Triggers to Identify Pediatric Patients at Risk for Nephrotoxic Medication-associated Harm

Applied Clinical Informatics ◽

10.4338/aci-2013-12-ra-0102 ◽

2014 ◽

Vol 05 (02) ◽

pp. 313-333 ◽

Cited By ~ 38

Author(s):

W.L. Spires ◽

T.A. Mottes ◽

J.K. Schaffzin ◽

C. Barclay ◽

S.L. Goldstein ◽

...

Keyword(s):

At Risk ◽

Acute Kidney Injury ◽

Pediatric Patients ◽

Data Entry ◽

Kidney Injury ◽

Clinical Work ◽

Web Based ◽

Predictive Values ◽

Patients At Risk ◽

And Performance

Summary Background: Nephrotoxic medication-associated acute kidney injury (NTMx-AKI) is a costly clinical phenomenon and more common than previously recognized. Prior efforts to use technology to identify AKI have focused on detection after renal injury has occurred. Objectives: Describe an approach and provide a technical framework for the creation of risk-stratifying AKI triggers and the development of an application to manage the AKI trigger data. Report the performance characteristics of those triggers and the refinement process and on the challenges of implementation. Methods: Initial manual trigger screening guided design of an automated electronic trigger report. A web-based application was designed to alleviate inefficiency and serve as a user interface and central workspace for the project. Performance of the NTMx exposure trigger reports from September 2011 to September 2013 were evaluated using sensitivity (SN), specificity (SP), positive and negative predictive values (PPV, NPV). Results: Automated reports were created to replace manual screening for NTMx-AKI. The initial performance of the NTMx exposure triggers for SN, SP, PPV, and NPV all were 0.78, and increased over the study, with all four measures reaching 0.95 consistently. A web-based application was implemented that simplifies data entry and couriering from the reports, expedites results viewing, and interfaces with an automated data visualization tool. Sociotechnical challenges were logged and reported. Conclusion: We have built a risk-stratifying system based on electronic triggers that detects patients at-risk for NTMx-AKI before injury occurs. The performance of the NTMx-exposed reports has neared 100% through iterative optimization. The complexity of the trigger logic and clinical work-flows surrounding NTMx-AKI led to a challenging implementation, but one that has been successful from technical, clinical, and quality improvement standpoints. This report summarizes the construction of a trigger-based application, the performance of the triggers, and the challenges uncovered during the design, build, and implementation of the system. Citation: Kirkendall ES, Spires WL, Mottes TA, Schaffzin JK, Barclay C, Goldstein SL. Development and performance of electronic acute kidney injury triggers to identify pediatric patients at risk for nephrotoxic medication-associated harm. Appl Clin Inf 2014; 5: 313–333 http://dx.doi.org/10.4338/ACI-2013-12-RA-0102

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Renal Involvement in COVID-19 Among Iranian Children

Archives of Pediatric Infectious Diseases ◽

10.5812/pedinfect.106597 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Masoumeh Mohkam ◽

Mahbube Mirzaee ◽

Fatemeh Abdollah Gorgi ◽

Sedigheh Rafiei Tabatabaei ◽

Abdollah Karimi ◽

...

Keyword(s):

Pediatric Patients ◽

Clinical Symptoms ◽

Kidney Diseases ◽

Renal Involvement ◽

Total Mortality ◽

Kidney Injury ◽

Background Information ◽

Hospital Death ◽

Cross Sectional ◽

Failure Group

Background: Information about renal involvement in pediatric patients with COVID-19 is limited, and there is not enough data about renal and urinary tract involvement in children infected with this novel virus. Objectives: This study aimed to determine the spectrum of kidney diseases in pediatric patients with COVID-19, admitted to a tertiary children’s hospital. Methods: This cross-sectional study was conducted on 71 pediatric patients with COVID-19 infection. Diagnosis of COVID-19 was established based on the guidelines by the Iranian Ministry of Health. The patients’ demographic characteristics, clinical symptoms, laboratory results, and renal ultrasonography findings were extracted from the hospital medical records. Results: On admission, 10% of patients had oliguria, 7.7% had edema, and 3% had hypertension. The first urinalysis indicated proteinuria, leukocyturia, and hematuria in 46%, 24%, and 23% of the patients, respectively. Overall, 40.7% of the patients showed some degree of renal involvement. During hospitalization, acute kidney injury (AKI) occurred in 34.5% of the patients. Based on the pediatric risk, injury, failure, loss of kidney function, and end-stage kidney disease (pRIFLE) classification, stage I (risk group) was found in 20% of patients, stage II (injury group) in 25% of patients, and stage III (failure group) in 55% of patients with AKI. The total mortality rate was estimated at 12.67%, and the incidence of in-hospital death was 30% in pediatric patients with severe COVID-19 infection associated with AKI. Conclusions: The prevalence of AKI was high in patients with COVID-19 infection hospitalized in our tertiary hospital. We also found that a decrease in renal function was associated with a higher risk of mortality. Overall, early detection of AKI and effective treatment may help reduce mortality in patients with COVID-19.

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The Kynurenine Pathway in Acute Kidney Injury and Chronic Kidney Disease

American Journal of Nephrology ◽

10.1159/000519811 ◽

2021 ◽

pp. 1-17

Author(s):

Hai Ning Wee ◽

Jian-Jun Liu ◽

Jianhong Ching ◽

Jean-Paul Kovalik ◽

Su Chi Lim

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Animal Models ◽

Kidney Diseases ◽

Kidney Injury ◽

Kynurenine Pathway ◽

T Cell Subsets ◽

Renal Diseases ◽

Tryptophan Degradation

Background: The kynurenine pathway (KP) is the major catabolic pathway for tryptophan degradation. The KP plays an important role as the sole de novo nicotinamide adenine dinucleotide (NAD+) biosynthetic pathway in normal human physiology and functions as a counter-regulatory mechanism to mitigate immune responses during inflammation. Although the KP has been implicated in a variety of disorders including Huntington’s disease, seizures, cardiovascular disease, and osteoporosis, its role in renal diseases is seldom discussed. Summary: This review summarizes the roles of the KP and its metabolites in acute kidney injury (AKI) and chronic kidney disease (CKD) based on current literature evidence. Metabolomics studies demonstrated that the KP metabolites were significantly altered in patients and animal models with AKI or CKD. The diagnostic and prognostic values of the KP metabolites in AKI and CKD were highlighted in cross-sectional and longitudinal human observational studies. The biological impact of the KP on the pathophysiology of AKI and CKD has been studied in experimental models of different etiologies. In particular, the activation of the KP was found to confer protection in animal models of glomerulonephritis, and its immunomodulatory mechanism may involve the regulation of T cell subsets such as Th17 and regulatory T cells. Manipulation of the KP to increase NAD+ production or diversion toward specific KP metabolites was also found to be beneficial in animal models of AKI. Key Messages: KP metabolites are reported to be dysregulated in human observational and animal experimental studies of AKI and CKD. In AKI, the magnitude and direction of changes in the KP depend on the etiology of the damage. In CKD, KP metabolites are altered with the onset and progression of CKD all the way to advanced stages of the disease, including uremia and its related vascular complications. The activation of the KP and diversion to specific sub-branches are currently being explored as therapeutic strategies in these diseases, especially with regards to the immunomodulatory effects of certain KP metabolites. Further elucidation of the KP may hold promise for the development of biomarkers and targeted therapies for these kidney diseases.

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Nephrology

Oxford Handbook for Medical School ◽

10.1093/med/9780199681907.003.0021 ◽

2019 ◽

pp. 413-436

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Peritoneal Dialysis ◽

Kidney Injury ◽

Renal Diseases ◽

Glomerular Diseases ◽

Conservative Care ◽

Clinical Syndromes ◽

Intravenous Fluid Administration

Nephrology is the study of the kidney and its diseases. This chapter describes the aetiology, presentation, and management of the main clinical syndromes of acute kidney injury, chronic kidney disease, glomerular diseases causing nephrotic syndrome, and glomerulonephritis, and the different modalities of renal replacement therapy: haemodialysis, peritoneal dialysis, renal transplantation, and conservative care. Practical skills of fluid assessment and intravenous fluid administration are discussed, as well as procedures including renal biopsy, dialysis line insertion, and arteriovenous fistula creation. Key components of the ‘renal examination’ and renal investigations are summarized. Renal diseases in the setting of multisystem disorders such as myeloma, rhabdomyolysis, and liver disease are also described.

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Renal Diseases Associated with Hematologic Malignancies and Thymoma in the Absence of Renal Monoclonal Immunoglobulin Deposits

Diagnostics ◽

10.3390/diagnostics11040710 ◽

2021 ◽

Vol 11 (4) ◽

pp. 710

Author(s):

Antoine Morel ◽

Marie-Sophie Meuleman ◽

Anissa Moktefi ◽

Vincent Audard

Keyword(s):

Kidney Diseases ◽

Specific Treatment ◽

Kidney Injury ◽

Myeloproliferative Disorders ◽

Hematologic Malignancies ◽

Lymphocytic Leukemia ◽

Renal Diseases ◽

Diagnostic Strategy ◽

Monoclonal Immunoglobulin ◽

Glomerular Diseases

In addition to kidney diseases characterized by the precipitation and deposition of overproduced monoclonal immunoglobulin and kidney damage due to chemotherapy agents, a broad spectrum of renal lesions may be found in patients with hematologic malignancies. Glomerular diseases, in the form of paraneoplastic glomerulopathies and acute kidney injury with various degrees of proteinuria due to specific lymphomatous interstitial and/or glomerular infiltration, are two major renal complications observed in the lymphoid disorder setting. However, other hematologic neoplasms, including chronic lymphocytic leukemia, thymoma, myeloproliferative disorders, Castleman disease and hemophagocytic syndrome, have also been associated with the development of kidney lesions. These renal disorders require prompt recognition by the clinician, due to the need to implement specific treatment, depending on the chemotherapy regimen, to decrease the risk of subsequent chronic kidney disease. In the context of renal disease related to hematologic malignancies, renal biopsy remains crucial for accurate pathological diagnosis, with the aim of optimizing medical care for these patients. In this review, we provide an update on the epidemiology, clinical presentation, pathophysiological processes and diagnostic strategy for kidney diseases associated with hematologic malignancies outside the spectrum of monoclonal gammopathy of renal significance.

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Acute Kidney Injury in Pediatric Patients with COVID-19; Clinical Features and Outcome

10.21203/rs.3.rs-850994/v1 ◽

2021 ◽

Author(s):

Masoumeh Mohkam ◽

Mahbube Mirzaee ◽

Mahnaz Jamee ◽

Fatemeh Abdollah Gorji ◽

Mitra Khalili ◽

...

Keyword(s):

Acute Kidney Injury ◽

Pediatric Patients ◽

Renal Involvement ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Learning Disorders ◽

Laboratory Findings ◽

Renal Disorders ◽

Kidney Involvement ◽

Stage 1

Abstract Background:Renal disorders are reported as both underlying conditions and complications in critical pediatric COVID-19 infection. Herein, we investigated the pattern of renal involvement, particularly acute kidney injury (AKI), among pediatric patients with COVID-19.MethodsWe prospectively enrolled hospitalized pediatric patients with the clinical diagnosis of COVID-19 infection. Demographic, clinical, and laboratory findings were gathered and analyzed, using a mixed method of qualitative and quantitative approaches and descriptive statistics.Results187 patients including 120 (64.2%) male and 67 (35.8%) female with COVID-19 infection at a median (interquartile range) of 60 (24-114) months were enrolled in this study.Most patients (n=108, 58.1%) were suffered from one or two underlying comorbidities, mainly malnutrition (77.4%), neurologic/learning disorders (21.4%) and malignancy (10.2%). Kidney was the third organ involved in 30 patients (16%) during hospital admission, after lung (53.5%) and gastrointestinal tract (39%). According to the KDIGO definition and classification, AKI was detected in 38.5% of patients (stage 1: 55.6%, stage 2: 36.1%, stage 3: 8.3%) at presentation or during follow up. Nine patients (4.8%) required hemodialysis and 16 (8.6%) patients were eventually died. There was no significant association between AKI and pediatric intensive care unit (PICU) admission (p=0.079), multisystem inflammatory syndrome in children (MIS-C) (p=0.051), comorbidities (p=0.067), and mortality rate (p=0.789).ConclusionsKidneys are one of the major organs affected by COVID-19 infection. Although kidney abnormalities resolve in the majority of pediatric COVID-19 infection, particular attention should be given to kidney involvement in COVID-19 patients, particularly children with history of malnutrition and renal disorders.

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Assessment of Clinical Spectrum of Renal Diseases in children – A Descriptive Study at Benazir Bhutto Hospital, Rawalpindi

Journal of Rawalpindi Medical College ◽

10.37939/jrmc.v25i1.1441 ◽

2021 ◽

Vol 25 (1) ◽

pp. 42-47

Author(s):

Maria Shamsher ◽

Sadaf Ijaz ◽

Mobeen Tabassum ◽

Rai Muhammad Asghar

Keyword(s):

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Renal Disease ◽

Kidney Diseases ◽

Heart Diseases ◽

Health Planning ◽

Kidney Injury ◽

Descriptive Study ◽

Renal Diseases ◽

Institutional Review

Introduction: Childhood kidney diseases are a frequent presentation. Most of the affected pediatric populations are from under-developed and developing countries. Noting the epidemiology of childhood renal diseases is very important as it helps in health planning, allows for adequate resource allocation, and enables adequate renal services provision. This study aimed to determine the etiological spectrum of renal disease in pediatric patients. Material and Methods: A descriptive study was conducted in Benazir Bhutto Hospital, Rawalpindi over a period of 6 months. Ethical clearance was taken from the institutional review board and written informed consent was administered before enrollment of subject per study criteria. A total of 100 children of both genders, aged up to 12 years with the diagnosis of any renal disease condition were included in the study. Patients having other comorbidities like chronic liver disease and heart diseases were excluded. The study information as age, sex, detailed history, and physical examination, and details of laboratory investigations. Statistical analysis was conducted in SPSS version 20.0. Results: Mean age of patients was 2.1 years. Most patients had a fever, edema, burning micturition, and high blood pressure. In two-thirds of the children RFTs were deranged and 19.0% had positive urinary culture reports. The common kidney diseases were UTI (42.0%), nephrotic syndrome (29.0%), acute kidney injury/ disease (19.0%), and chronic kidney disease (6.0%). Conclusion: UTIs and nephrotic syndrome along with acute kidney injury were the main kidney conditions. Females were more likely to have UTIs whereas nephrotic syndrome was common in male children.

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Covid-19 and its relationship with kidney diseases: a scope review

Journal of Human Growth and Development ◽

10.36311/jhgd.v31.12782 ◽

2021 ◽

Vol 31 (3) ◽

pp. 533-548

Author(s):

Jennifer Soanno Marchiori ◽

Miguel Athos Da Silva De Oliveira ◽

Italla Maria Pinheiro Bezerra

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Diseases ◽

Renal Involvement ◽

Kidney Injury ◽

The Body ◽

Warning Signs ◽

Constant Attention ◽

Disease Evolution ◽

Coronavirus Infection

Background: COVID-19 is an acute respiratory disease originally from China that emerged in December 2019 and quickly spread around the world, affecting 230,418.415 people, and causing 4,724,876 deaths. Coming from the coronavirus family, SARS-CoV-2 is a new subtype of virus that affects the respiratory tract in different levels and can spread and affect other vital structures in the body. Objective: To identify the risk factors that lead patients infected by the new coronavirus to develop kidney disease. Methods: This is a systematic review of the Scoping Review type (scope review), according to the method proposed by the Joanna Briggs Institute, with the implementation of a checklist structured by PRISMA-ScR that contains 22 mandatory items. The following descriptors were used: coronavirus infection, acute kidney injury and risk factors in five databases, namely PudMed, Scopus, Embase, Virtual Health Library and Web of Science. Results: While reading the studies, it was concluded that Acute Kidney Injury was the main renal finding in patients contaminated by SARS-CoV-2. The risk factors for developing renal worsening in patients with COVID-19 were the extremes of age, race, sex, pre-existing diseases, and the disease evolution. Conclusion: It is assumed that renal involvement does not occur only for an exclusive reason, but as a set of factors. It is up to the health team to pay constant attention to the warning signs by monitoring the contaminated patient.

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