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COVID-19 in children treated with immunosuppressive medication for kidney diseases
  1. Matko Marlais1,2,
  2. Tanja Wlodkowski3,
  3. Samhar Al-Akash4,
  4. Petr Ananin5,
  5. Varun Kumar Bandi6,
  6. Veronique Baudouin7,
  7. Olivia Boyer8,
  8. Luciola Vásquez9,
  9. Sukanya Govindan10,
  10. Nakysa Hooman11,
  11. Iftikhar Ijaz12,
  12. Reyner Loza13,
  13. Marta Melgosa14,
  14. Nivedita Pande15,
  15. Lars Pape16,
  16. Anshuman Saha17,
  17. Dmitry Samsonov18,
  18. Michiel F Schreuder19,
  19. Jyoti Sharma20,
  20. Sahar Siddiqui21,
  21. Rajiv Sinha22,
  22. Heather Stewart23,
  23. Velibor Tasic24,
  24. Burkhard Tönshoff25,
  25. Katherine Twombley26,
  26. Kiran Upadhyay27,
  27. Marina Vivarelli28,
  28. Donald J Weaver29,
  29. Robert Woroniecki30,
  30. Franz Schaefer3,
  31. Kjell Tullus2
  1. 1UCL Great Ormond Street Institute of Child Health, University College London, London, UK
  2. 2Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  3. 3Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
  4. 4Driscoll Children's Kidney Center, Driscoll Children's Hospital, Corpus Christi, Texas, USA
  5. 5Pediatric Nephrology, National Medical Research Center for Children's Health, Moscow, Russian Federation
  6. 6Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and RF, Vijayawada, India
  7. 7Hopital Universitaire Robert Debre-APHP, Paris, France
  8. 8Service de Néphrologie pédiatrique, Centres de référence MARHEA et SNI, Université de Paris, Inserm U1163, Hôpital Necker-Enfants malades, AP-HP, Paris, France
  9. 9Pediatric Nephrology Transplant Department, G.Almenara Hospital, Lima, Peru
  10. 10Department of Paediatric Nephrology, Mehta Multispecialty Hospitals, Chennai, India
  11. 11Aliasghar Clinical Research Development Center, Aliasghar Children hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran (the Islamic Republic of)
  12. 12Children's Kidney Centre, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
  13. 13Nephrology Paediatric Unit, Department of Pediatrícs, Cayetano Heredia National Hospital, Lima, Peru
  14. 14Pediatric Nephrology Department, La Paz University Hospital, Madrid, Spain
  15. 15Department of Pediatrics, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, India
  16. 16Department of Paediatrics II, University Hospital Essen, Essen, Germany
  17. 17Pediatric Nephrology, Institute Of Kidney Diseases And Research Center And Institute Of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
  18. 18New York Medical College, Valhalla, New York, USA
  19. 19Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
  20. 20King Edward Memorial Hospital, Pune, India
  21. 21Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
  22. 22ICH, Institute of Child Health, Kolkata, India
  23. 23Dwaine & Cynthia Willet Children's Hospital, Savannah, Georgia, USA
  24. 24Paediatric Nephrology, University Children's Hospital, Skopje, North Macedonia
  25. 25Department of Pediatrics I, University Children’s Hospital, Heidelberg, Germany
  26. 26Medical University of South Carolina, Charleston, South Carolina, USA
  27. 27Division of Pediatric Nephrology, University of Florida, Gainesville, Florida, USA
  28. 28Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
  29. 29Division of Pediatric Nephrology and Hypertension, Atrium Health Levine Children’s, Charlotte, North Carolina, USA
  30. 30Stony Brook Children's Hospital, New York City, New York, USA
  1. Correspondence to Dr Matko Marlais, Institute of Child Health, University College London, London, UK; m.marlais{at}


Background Children are recognised as at lower risk of severe COVID-19 compared with adults, but the impact of immunosuppression is yet to be determined. This study aims to describe the clinical course of COVID-19 in children with kidney disease taking immunosuppressive medication and to assess disease severity.

Methods Cross-sectional study hosted by the European Rare Kidney Disease Reference Network and supported by the European, Asian and International paediatric nephrology societies. Anonymised data were submitted online for any child (age <20 years) with COVID-19 taking immunosuppressive medication for a kidney condition. Study recruited for 16 weeks from 15 March 2020 to 05 July 2020. The primary outcome was severity of COVID-19.

Results 113 children were reported in this study from 30 different countries. Median age: 13 years (49% male). Main underlying reasons for immunosuppressive therapy: kidney transplant (47%), nephrotic syndrome (27%), systemic lupus erythematosus (10%). Immunosuppressive medications used include: glucocorticoids (76%), mycophenolate mofetil (MMF) (54%), tacrolimus/ciclosporine A (58%), rituximab/ofatumumab (11%). 78% required no respiratory support during COVID-19 illness, 5% required bi-level positive airway pressure or ventilation. Four children died; all deaths reported were from low-income countries with associated comorbidities. There was no significant difference in severity of COVID-19 based on gender, dialysis status, underlying kidney condition, and type or number of immunosuppressive medications.

Conclusions This global study shows most children with a kidney disease taking immunosuppressive medication have mild disease with SARS-CoV-2 infection. We therefore suggest that children on immunosuppressive therapy should not be more strictly isolated than children who are not on immunosuppressive therapy.

  • nephrology
  • virology

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  • Twitter @al_samhar, @NeckerNephroPed, @GovindDrsuk

  • Contributors KT, FS, MM and TW devised the idea for the study, KT, FS, MM, TW, LP, BT and MV planned the study set-up and coordinated the study data collection. All authors contributed to study data collection and reviewing of the manuscript to be published. All authors have reviewed the manuscript and all those named in the acknowledgements have given written consent to do so. MM had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This survey has been supported by European Rare Kidney Disease Reference Network (ERKNet). ERKNet is co-funded by the European Union within the framework of the Third Health Programme 'ERN-2016 Framework Partnership Agreement 2017–2021'.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request.

  • 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.

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