COVID-19 and Renal Complications in Neonates and Pediatrics

Letter to Editor


1 Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Medical Genetics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Mother and Newborn Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

4 Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran


Dear editor,
Several studies stated that course of COVID-19 in children is considerably better than adults.1–3 COVID-19 mortality rates in infected children is less than 1%.4,5 Some studies indicated the importance of renal function surveillance among infected children with COVID-19.4 However, there was no sufficient data on renal complications in infected children. The available data showed that ventilation in the infected children might be less aggressive and had less systemic involvement and renal dysfunction than adult patients.5 Normal renal function defined by serum creatinine (SCr) greater than 110 μmol/L or serum urea greater than 7 mmol/L. Shah et al., reported that the infection might be associated with new-onset nephrotic syndrome in the children.6 A study from northern China evaluated the epidemiological history, clinical manifestations, treatment and the short-term prognosis of 31 infected children (6 months -17 years) from six provinces. The study showed that the clinical manifestations and laboratory examination results are nonspecific in the infected children. Moreover, renal function and blood glucose were normal in the infected children.7 Other study among nine Chinese infected infants (age ranges: 1-11 months) showed that those infants did not require intensive care and had no serious complications.8 In a study, Qui et al. described the clinical and epidemiological characteristics of 36 Chinese hospitalized children (age 0–16 years). Their results showed that none of the children had renal dysfunction.9 Stewart et al., described data of 52 infected children (age 0–16 years) who referred to Great Ormond Street Hospital for Children NHS Foundation Trust (London, UK). Their data showed that 24 (46%) of those children had a SCr greater than the upper limit of reference interval (ULRI), and 15 (29%) met the British Association of Pediatric Nephrology (BAPN) diagnostic criteria for acute kidney injury (AKI). Moreover, most cases of AKI occurred in those children who admitted to the pediatrics ICU (PICU) and those children with pediatrics inflammatory multisystem syndrome temporarily associated with the infection.4 Deep et al., have reported that the incidence of AKI in infected children might be between 2% and 3%.5 But, their reports was less than the epidemiology of 26% renal dysfunction in children admitted to PICU.10 Moreover, González-Dambrauskas et al., in a multicenter epidemiological study of critically ill children indicated that AKI occurred in 18% of patients. They proposed that pediatric patients with a comorbidity such as congenital heart diseases and congenital renal diseases and renal transplant patients are at higher risk of renal complications.11

1. Jarahzadeh HM, Asadian F, Farbod M, Meibodi B, Abbasi H, Jafari M, et al. Cancer and coronavirus disease (COVID-19): Comorbidity, mechanical ventilation, and death risk. J Gastrointest Cancer 2021; 52(1): 80-84.
2. Antikchi MH, Neamatzadeh H, Ghelmani Y, Jafari-Nedooshan J, Dastgheib SA, Kargar S, et al. The risk and prevalence of COVID-19 infection in colorectal cancer patients: A systematic review and meta-analysis. J Gastrointest Cancer. 2021; 52(1): 73-79.
3. Karimi-Zarchi M, Neamatzadeh H, Dastgheib SA, Abbasi H, Mirjalili SR, Behforouz A, et al. Vertical transmission of coronavirus disease 19 (COVID-19) from infected pregnant mothers to neonates: A review. Fetal Pediatr Pathol 2020; 39(3):246-50.
4. Stewart DJ, Hartley JC, Johnson M, Marks SD, du Pré P, Stojanovic J. Renal dysfunction in hospitalised children with COVID-19. Lancet Child Adolesc Health 2020; 4(8): e28-e29.
5. Deep A, Bansal M, Ricci Z. Acute kidney injury and special considerations during renal replacement therapy in children with coronavirus disease-19: Perspective from the critical care nephrology section of the european society of pediatric and neonatal intensive care. Blood Purif 2021; 50(2): 150-60.
6. Shah SA, Carter HP. New-onset nephrotic syndrome in a child associated with COVID-19 infection. Front Pediatr 2020; 8: 471.
7. Wang D, Ju XL, Xie F, Lu Y, Li FY, Huang HH, et al. [Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China]. Zhonghua Er Ke Za Zhi 2020; 58(4): 269-74. [In Chinese].
8. Hong H, Wang Y, Chung HT, Chen CJ. Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborns, infants and children. Pediatr Neonatol 2020; 61(2): 131-2.
9. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: An observational cohort study The Lancet Infectious Diseases 2020;20(6):689-96.
10. Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL. Epidemiology of acute kidney injury in critically Ill children and young adults. N Engl J Med 2017; 376(1): 11-20.
11. González-Dambrauskas S, Vásquez- Hoyos P, Camporesi A, Díaz-Rubio F, Piñeres-Olave BE, Fernández-Sarmiento J, et al. Pediatric critical care and COVID-19 pediatrics 2020;146(3):e20201766.