The Spectrum of Kidney Disorders in Children Infected with COVID-19: A Retrospective Cohort Study

Abstract

Background. The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has impacted various organ systems, including the kidneys, in adults and children. While acute kidney injury (AKI) is well-documented in adults with COVID-19, there is limited data on kidney involvement in pediatric patients, especially in resource-limited settings like the Philippines. This study explores the spectrum of kidney diseases in children infected with COVID-19.

Objective. The study aims to characterize the incidence and types of kidney dysfunction in pediatric COVID-19 patients, identify associated risk factors, and evaluate patient outcomes, including the need for renal replacement therapy (RRT) and mortality rates.

Methods. This retrospective cohort study analyzed pediatric patients diagnosed with SARS-CoV-2 infection via RTPCR, admitted to the Philippine General Hospital from March 2020 to April 2023. Patients with prior kidney disease were excluded. Data on demographic characteristics, clinical status, comorbidities, and laboratory findings were collected. Kidney dysfunction was defined as AKI, proteinuria, hematuria, or glucosuria. Associations between kidney dysfunction, COVID-19 severity, and patient outcomes were analyzed using logistic regression.

Results. Of the 316 pediatric COVID-19 patients included, 47.78% (151) had kidney involvement, most commonly hematuria (28.48%), proteinuria (26.27%), and AKI (14.60%). Severe and critical COVID-19 were significantly associated with kidney dysfunction, while comorbidities such as oncologic/hematologic conditions decreased the odds of proteinuria and glucosuria. AKI was associated with hypertension, fever, and severe COVID-19. Mortality was 12.03%, with AKI and critical COVID-19 being significant risk factors.

Conclusion. Kidney dysfunction is common in pediatric COVID-19 cases, particularly in severe disease. AKI was strongly associated with worse outcomes, including mortality. Early detection and management of kidney involvement are essential to improving prognosis in pediatric COVID-19 patients.