Renal Involvement in Multisystem Inflammatory Syndrome in Children: Not Only Acute Kidney Injury

• Main Authors: Alessandra Meneghel (Author), Valentina Masenello (Author), Fiorenza Alfier (Author), Stefania Giampetruzzi (Author), Camilla Sembenini (Author), Giorgia Martini (Author), Francesca Tirelli (Author), Davide Meneghesso (Author), Francesco Zulian (Author)
• Format: Book
• Published: MDPI AG, 2023-10-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.3390/children10101661; 2227-9067
• Keywords: MISC; SARS-CoV-2; kidney; AKI; tubular dysfunction; Pediatrics; RJ1-570
• Source: Children, Vol 10, Iss 10, p 1661 (2023)

Kidney involvement has been poorly investigated in SARS-CoV-2 Multisystem Inflammatory Syndrome in Children (MIS-C). To analyze the spectrum of renal involvement in MIS-C, we performed a single-center retrospective observational study including all MIS-C patients diagnosed at our Pediatric Department between April 2020 and May 2022. Demographic, clinical, pediatric intensive care unit (PICU) admission's need and laboratory data were collected at onset and after 6 months. Among 55 MIS-C patients enrolled in the study, kidney involvement was present in 20 (36.4%): 13 with acute kidney injury (AKI) and 7 with isolated tubular dysfunction (TD). In eight patients, concomitant AKI and TD was present (AKI-TD). AKI patients needed higher levels of intensive care (PICU: 61.5%, <i>p</i> < 0.001; inotropes: 46.2%, <i>p</i> = 0.002; second-line immuno-therapy: 53.8%, <i>p</i> < 0.001) and showed lower levels of HCO3- (<i>p</i> = 0.012), higher inflammatory markers [neutrophils (<i>p</i> = 0.092), PCT (<i>p</i> = 0.04), IL-6 (<i>p</i> = 0.007)] as compared to no-AKI. TD markers showed that isolated TD presented higher levels of HCO3- and lower inflammatory markers than AKI-TD. Our results indicate a combination of both pre-renal and inflammatory damage in the pathogenesis of kidney injury in MIS-C syndrome. We highlight, for the first time, the presence of tubular involvement in MIS-C, providing new insights in the evaluation of kidney involvement and its management in this condition.