Abstract
Background
Our aim was to identify acute kidney injury (AKI) and subacute kidney injury using both KDIGO criteria and urinary biomarkers in children with mild/moderate COVID-19.
Methods
This cross-sectional study included 71 children who were hospitalized with a diagnosis of COVID-19 from 3 centers in Istanbul and 75 healthy children. We used a combination of functional (serum creatinine) and damage (NGAL, KIM-1, and IL-18) markers for the definition of AKI and subclinical AKI. Clinical and laboratory features were evaluated as predictors of AKI and subclinical AKI.
Results
Patients had significantly higher levels of urinary biomarkers and urine albumin–creatinine ratio than healthy controls (p < 0.001). Twelve patients (16.9%) developed AKI based on KDIGO criteria, and 22 patients (31%) had subclinical AKI. AKI group had significantly higher values of neutrophil count on admission than both subclinical AKI and non-AKI groups (p < 0.05 for all). Neutrophil count was independently associated with the presence of AKI (p = 0.014).
Conclusions
This study reveals that even children with a mild or moderate disease course are at risk for AKI. Association between neutrophil count and AKI may point out the role of inflammation in the development of AKI.
Impact
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The key message of our article is that not only children with severe disease but also children with mild or moderate disease have an increased risk for kidney injury due to COVID-19.
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Urinary biomarkers enable the diagnosis of a significant number of patients with subclinical AKI in patients without elevation in serum creatinine.
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Our findings reveal that patients with high neutrophil count may be more prone to develop AKI and should be followed up carefully.
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We conclude that even children with mild or moderate COVID-19 disease courses should be evaluated for AKI and subclinical AKI, which may improve patient outcomes.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Funding
This work was supported by Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa (Project number: 34892).
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S.S. and N.C. designed the project, provided funding acquisition, contributed to analysis and interpretation of the results, drafting the initial manuscript, editing the manuscript, and subsequent critical revisions. R.Y.C., A.A., E.K.Y., A.A.K.S., D.A., G.A., K.C.D., and D.K. completed the acquisition of clinical and laboratory data. H.C., S.C., and L.S. contributed to the review of the article. All authors read and approved the final version of the manuscript and agree to be accountable for all aspects of the work.
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The authors declare no competing interests.
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The study protocol and this consent procedure were approved by the local Ethics Committee (number: 57696, April 2020). The procedure was conducted with the written and informed consent of the parents or guardians of the minors and in accordance with all applicable ethical and legal rules concerning medical research involving human studies in the Declaration of Helsinki ethical statement.
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Saygili, S., Canpolat, N., Cicek, R.Y. et al. Clinical and subclinical acute kidney injury in children with mild-to-moderate COVID-19. Pediatr Res 93, 654–660 (2023). https://doi.org/10.1038/s41390-022-02124-6
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DOI: https://doi.org/10.1038/s41390-022-02124-6
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