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Impact of COVID-19 on the clinical course of nephrotic syndrome in children: a single-center study

  • Min Ji, Park (Department of Pediatrics, School of Medicine, Kyungpook National University) ;
  • Jung Kwan, Eun (Department of Pediatrics, School of Medicine, Kyungpook National University) ;
  • Hee Sun, Baek (Department of Pediatrics, Yeungnam University College of Medicine) ;
  • Min Hyun, Cho (Department of Pediatrics, School of Medicine, Kyungpook National University)
  • Received : 2022.09.16
  • Accepted : 2022.10.31
  • Published : 2022.12.31

Abstract

Purpose: Children with nephrotic syndrome may experience disease relapse or aggravation triggered by various viral infections. Limited studies on the clinical implications of the coronavirus disease 2019 (COVID-19) pandemic in children with nephrotic syndrome have been published worldwide. Therefore, this study aimed to investigate the effects of COVID-19 on the clinical course of nephrotic syndrome in children. Methods: The medical records of 59 patients with idiopathic nephrotic syndrome who visited our hospital between February and June 2022 were retrospectively analyzed. Results: Twenty of the total 59 patients with nephrotic syndrome were diagnosed with COVID-19 during the study period. The mean age at the time of the diagnosis of nephrotic syndrome and COVID-19 in all 20 patients was 4.6±3.5 and 8.9±3.9 years, respectively. Three patients (15%) were diagnosed with nephrotic syndrome relapse during COVID-19 and the relapse rate was similar to them without COVID-19 (20.5%, 8/39 patients). At the time of the COVID-19 diagnosis, fever (85%) and cough (40%) were the most common symptoms. After the diagnosis of COVID-19, all patients showed improvement with symptomatic treatment, including antipyretic analgesics and cold medicine. None of the critical patients required hospitalization or oral antiviral medications. Conclusions: Despite the use of immunosuppressants, the clinical manifestations of COVID-19 in children with nephrotic syndrome were not severe and are expected to be similar to that in the general population. The relapse rate of nephrotic syndrome in children with COVID-19 was also not different from them without COVID-19.

Keywords

References

  1. Korea Disease Control and Prevention Agency. Coronavirus (COVID-19) [Internet]. Cheongju: Korea Disease Control and Prevention Agency; c2022 [cited 2022 Sep 5]. Available from: http://ncov.mohw.go.kr/en/.
  2. Lebedev L, Sapojnikov M, Wechsler A, Varadi-Levi R, Zamir D, Tobar A, et al. Minimal change disease following the Pfizer-BioNTech COVID-19 vaccine. Am J Kidney Dis 2021;78:142-5. https://doi.org/10.1053/j.ajkd.2021.03.010
  3. Klomjit N, Alexander MP, Fervenza FC, Zoghby Z, Garg A, Hogan MC, et al. COVID-19 vaccination and glomerulonephritis. Kidney Int Rep 2021;6:2969-78.
  4. Kudose S, Batal I, Santoriello D, Xu K, Barasch J, Peleg Y, et al. Kidney biopsy findings in patients with COVID-19. J Am Soc Nephrol 2020;31:1959-68.
  5. Batlle D, Soler MJ, Sparks MA, Hiremath S, South AM, Welling PA, et al. Acute kidney injury in COVID-19: emerging evidence of a distinct pathophysiology. J Am Soc Nephrol 2020;31:1380-3. https://doi.org/10.1681/ASN.2020040419
  6. Bomback AS, Kudose S, D'Agati VD. De novo and relapsing glomerular diseases after COVID-19 vaccination: what do we know so far? Am J Kidney Dis 2021;78:477-80. https://doi.org/10.1053/j.ajkd.2021.06.004
  7. Bjornstad EC, Krallman KA, Askenazi D, Zappitelli M, Goldstein SL, Basu RK, et al. Preliminary assessment of acute kidney injury in critically ill children associated with SARS-CoV-2 infection: a multicenter cross-sectional analysis. Clin J Am Soc Nephrol 2021;16:446-8. https://doi.org/10.2215/CJN.11470720
  8. Serafinelli J, Mastrangelo A, Morello W, Cerioni VF, Salim A, Nebuloni M, et al. Kidney involvement and histological findings in two pediatric COVID-19 patients. Pediatr Nephrol 2021;36:3789-93. https://doi.org/10.1007/s00467-021-05212-7
  9. Hanna C, Herrera Hernandez LP, Bu L, Kizilbash S, Najera L, Rheault MN, et al. IgA nephropathy presenting as macroscopic hematuria in 2 pediatric patients after receiving the Pfizer COVID-19 vaccine. Kidney Int 2021;100:705-6. https://doi.org/10.1016/j.kint.2021.06.032
  10. Kim L, Whitaker M, O'Halloran A, Kambhampati A, Chai SJ, Reingold A, et al. Hospitalization rates and characteristics of children aged <18 years hospitalized with laboratory-confirmed COVID-19: COVID-NET, 14 States, March 1-July 25, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1081-8. https://doi.org/10.15585/mmwr.mm6932e3
  11. de Souza TH, Nadal JA, Nogueira RJ, Pereira RM, Brandao MB. Clinical manifestations of children with COVID-19: a systematic review. Pediatr Pulmonol 2020;55:1892-9. https://doi.org/10.1002/ppul.24885
  12. Badal S, Thapa Bajgain K, Badal S, Thapa R, Bajgain BB, Santana MJ. Prevalence, clinical characteristics, and outcomes of pediatric COVID-19: a systematic review and meta-analysis. J Clin Virol 2021;135:104715.
  13. Parcha V, Booker KS, Kalra R, Kuranz S, Berra L, Arora G, et al. A retrospective cohort study of 12,306 pediatric COVID-19 patients in the United States. Sci Rep 2021;11:10231.
  14. Valverde I, Singh Y, Sanchez-de-Toledo J, Theocharis P, Chikermane A, Di Filippo S, et al. Acute cardiovascular manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe. Circulation 2021;143:21-32. https://doi.org/10.1161/CIRCULATIONAHA.120.050065
  15. Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med 2020;26:1017-32.
  16. Basalely A, Gurusinghe S, Schneider J, Shah SS, Siegel LB, Pollack G, et al. Acute kidney injury in pediatric patients hospitalized with acute COVID-19 and multisystem inflammatory syndrome in children associated with COVID-19. Kidney Int 2021;100:138-45. https://doi.org/10.1016/j.kint.2021.02.026
  17. Shah SA, Carter HP. New-onset nephrotic syndrome in a child associated with COVID-19 infection. Front Pediatr 2020;8:471.
  18. Alvarado A, Franceschi G, Resplandor E, Sumba J, Orta N. COVID-19 associated with onset nephrotic syndrome in a pediatric patient: coincidence or related conditions? Pediatr Nephrol 2021;36:205-7. https://doi.org/10.1007/s00467-020-04724-y
  19. MacDonald NE, Wolfish N, McLaine P, Phipps P, Rossier E. Role of respiratory viruses in exacerbations of primary nephrotic syndrome. J Pediatr 1986;108:378-82. https://doi.org/10.1016/S0022-3476(86)80876-9
  20. Uwaezuoke SN. Steroid-sensitive nephrotic syndrome in children: triggers of relapse and evolving hypotheses on pathogenesis. Ital J Pediatr 2015;41:19.
  21. Zhang H, Wang Z, Dong L, Guo Y, Wu J, Zhai S. New insight into the pathogenesis of minimal change nephrotic syndrome: role of the persistence of respiratory tract virus in immune disorders. Autoimmun Rev 2016;15:632-7. https://doi.org/10.1016/j.autrev.2016.02.007
  22. Crane C, Bakhoum C, Ingulli E. Rates of idiopathic childhood nephrotic syndrome relapse are lower during the COVID-19 pandemic. Pediatr Nephrol 2022;37:2679-85. https://doi.org/10.1007/s00467-022-05483-8
  23. Morello W, Vianello FA, Proverbio E, Peruzzi L, Pasini A, Montini G. COVID-19 and idiopathic nephrotic syndrome in children: systematic review of the literature and recommendations from a highly affected area. Pediatr Nephrol 2022;37:757-64. https://doi.org/10.1007/s00467-021-05330-2
  24. Angeletti A, Drovandi S, Sanguineri F, Santaniello M, Ferrando G, Forno R, et al. COVID-19 in children with nephrotic syndrome on anti-CD20 chronic immunosuppression. Clin J Am Soc Nephrol 2020;15:1494-5.
  25. Marlais M, Wlodkowski T, Al-Akash S, Ananin P, Bandi VK, Baudouin V, et al. COVID-19 in children treated with immunosuppressive medication for kidney diseases. Arch Dis Child 2020;106:798-801.
  26. Sinha R, Marlais M, Sarkar S, Obukhova V, Lucchetti L, Vasudevan A, et al. Impact of COVID-19 pandemic on use of rituximab among Children with difficult nephrotic syndrome. Pediatr Res 2022;92:3-5. https://doi.org/10.1038/s41390-021-01744-8
  27. Angeletti A, Bruschi M, Bigatti C, Palmeri S, Lugani F, Verrina E, et al. An update on COVID-19 in paediatric and young adults with nephrotic syndrome, receiving chronic immunosuppression during the Omicron pandemic. J Nephrol 2022;35:1775-6. https://doi.org/10.1007/s40620-022-01319-8