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  • Acute kidney injury in paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is not associated with progression to chronic kidney disease

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Original research
Acute kidney injury in paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is not associated with progression to chronic kidney disease
  1. Douglas John Stewart1,
  2. Nadeesha Lakmal Mudalige2,
  3. Mae Johnson3,
  4. Rukshana Shroff1,2,
  5. Pascale du Pré3,
  6. Jelena Stojanovic1
  1. 1 Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  2. 2 Institute of Child Health, University College London, London, UK
  3. 3 Department of Paediatric Intensive Care, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  1. Correspondence to Dr Jelena Stojanovic, Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; Jelena.Stojanovic{at}doctors.org.uk

Abstract

Background Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a rare complication of SARS-CoV-2 associated with single or multiorgan dysfunction.

Objective We aimed to evaluate the incidence of acute kidney injury (AKI) and risk factors for kidney dysfunction in PIMS-TS, with reporting of 6-month renal follow-up data. We also evaluated renal involvement between first and second waves of the SARS-CoV-2 pandemic in the UK, the latter attributed to the Alpha variant.

Design A single-centre observational study was conducted through patient chart analysis.

Setting Data were collected from patients admitted to Great Ormond Street Hospital, London, UK, between April 2020 and March 2021.

Patients 110 patients <18 years of age.

Main outcome measure AKI during hospitalisation. AKI classification was based on upper limit of reference interval (ULRI) serum creatinine (sCr) values.

Results AKI occurred in 33 (30%) patients. Hypotension/hypoperfusion was associated with almost all cases. In univariate analysis, the AKI cohort had higher peak levels of triglycerides (OR, 1.27 (95% CI, 1.05 to 1.6) per 1 mmol/L increase) and C reactive protein (OR, 1.06 (95% CI, 1.02 to 1.12) per 10 mg/L increase), with higher requirement for mechanical ventilation (OR, 3.8 (95% CI, 1.46 to 10.4)) and inotropic support (OR, 15.4 (95% CI, 3.02 to 2.81)). In multivariate analysis, triglycerides were independently associated with AKI stages 2–3 (adjusted OR, 1.26 (95% CI, 1.04 to 1.6)). At follow-up, none had macroalbuminuria and all had sCr values <ULRI. No discrepancy in renal involvement between pandemic waves was found.

Conclusion Despite a high incidence of AKI in PIMS-TS, renal recovery occurs rapidly with current therapies, and no patients developed chronic kidney disease.

  • COVID-19
  • nephrology
  • paediatrics

Data availability statement

Data are available upon reasonable request. De-identified patient datasets are available from the corresponding author on written request.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/archdischild-2021-322866

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    Data availability statement

    Data are available upon reasonable request. De-identified patient datasets are available from the corresponding author on written request.

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    Footnotes

    • Contributors DJS and JS conceptualised the report. DJS collected and analysed the data, and drafted the first manuscript. NLM analysed the data, performed statistical analyses and provided interpretation of results. MJ and PdP reviewed and updated the data. All authors edited and approved the final manuscript. DJS acts as guarantor.

    • Funding This project was conducted at Great Ormond Street Hospital NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health, which is supported by the National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.