Acute kidney injury: a post-COVID-19 complication in children and adolescents / Lesão renal aguda: uma complicação pós-COVID-19 em crianças e adolescentes

ABSTRACT Objective: To describe cases of acute kidney injury (AKI) in children diagnosed with COVID-19, associated risk factors, clinical aspects and outcome of cases. Methods: Retrospective study, carried out in a pediatric hospital between March 2020 and September 2021, with patients with COVID-19 who were diagnosed with AKI, studying information present in medical records such as comorbidities, age, gender and use of nephrotoxic medications. Results: We studied 40 cases, and male individuals were significantly more affected (62.5%; p=0.025). AKI was a severe complication of COVID-19 infection, with 100% of the sample requiring admission to the Intensive Care Unit and 22.5% dying. The most prevalent comorbidities analyzed in this study were epilepsy, cerebral palsy and heart disease. Most patients were classified according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria as KDIGO 1 (42.5%), and required orotracheal intubation (67.5%). The frequency of use of nephrotoxic medications and need for dialysis was low, with percentages of 35 and 17.5%, respectively. Among the children who died, 70.4% had some comorbidity and 88.8% received invasive ventilation. Conclusions: AKI in children with COVID-19 infection is associated with severe conditions. Despite the severity, most patients were discharged alive from the hospital.

RESUMO Objetivo: Descrever casos de lesão renal aguda (LRA) em crianças diagnosticadas com COVID-19, associando fatores de risco, aspectos clínicos e evolução dos casos. Métodos: Estudo retrospectivo, realizado em hospital pediátrico entre março de 2020 e setembro de 2021, com pacientes com COVID-19 diagnosticados com LRA, que examinou informações presentes em prontuários como comorbidades, idade, sexo e uso de medicações nefrotóxicas. Resultados: Foram estudados 40 casos, sendo o sexo masculino significativamente mais acometido (62,5%; p=0,025). A LRA foi uma complicação grave da infecção por COVID-19, com 100% da amostra necessitando de internação na Unidade de Terapia Intensiva e 22,5% indo a óbito. As comorbidades mais prevalentes analisadas neste estudo foram epilepsia, paralisia cerebral e cardiopatia. A maioria dos pacientes foi classificada pelos critérios Kidney Disease: Improving Global Outcomes (KDIGO) como KDIGO 1 (42,5%) e necessitou de intubação orotraqueal (67,5%). A frequência de uso de medicamentos nefrotóxicos e necessidade de diálise foi baixa, com percentuais de 35 e 17,5%, respectivamente. Entre as crianças que faleceram, 70,4% apresentavam alguma comorbidade e 88,8% receberam ventilação invasiva. Conclusões: A LRA em crianças com infecção por COVID-19 está associada a quadros graves, apesar de a maior parte dos pacientes ter recebido alta hospitalar.

Prevalence of Bladder and Bowel Dysfunction in the Outpatient Clinic of Pediatric Urology and Nephrology / Prevalencia de la disfunción de la vejiga y del intestino en la consulta ambulatoria de urología y nefrología pediátrica

Zoom Image Abstract Objective Bladder and bowel dysfunction (BBD) is defined as the presence of functional alterations in both organs. The correct diagnosis and treatment prevent the exposure of patients to multiple antibiotic treatments, invasive procedures and radiological studies. The aim of the present study was to estimate the prevalence of BBD in the outpatient clinic of pediatric urology and nephrology. Methods A prospective cohort composed of 334 patients aged between 5 and 18 years was evaluated. The Pediatric Lower Urinary Tract Symptom Score (PLUTSS) was applied. A score higher than 8 was considered as significant urinary symptomatology. Moreover, the Bristol Stool Scale and the Rome IV Criteria for functional constipation and fecal incontinence were used. Patients with organic pathologies were excluded. The risk factors were evaluated using logistic regression models. Results The median age was 9 years old (interquartile range [IQR]: 6­13). The PLUTSS questionnaire was significant in 16.5% of the kids, constipation was found in 31.9%, and fecal incontinence, in 4%. The prevalence of BBD was of 27.8%. The female gender (odds ratio [OR]: 2.47; p = 0.002) and psychological disorders (OR: 4.637; p = 0.024) were considered risk factors. The evaluation of the PLUTSS questionnaire showed relevance regarding incontinence (OR: 3.059; p = 0.038), enuresis (OR: 8.532; p < 0.001); intermittent flow (OR: 9.211; p = 0.004), frequency (OR: 6.73; p = 0.005), and constipation (OR: 34.46; p < 0.001). Conclusions The prevalence of BBD is of 27.8% in the outpatient clinic. It is important to prevent associated complications and the exposure to multiple antibiotic treatments, as well as invasive and imaging procedures, which also generate high costs to the health system.

Resumen Objetivo El síndrome de disfunción de la vejiga y del intestino (DVI) se define como la presencia de alteraciones funcionales en ambos órganos. El correcto diagnóstico y tratamiento previene la exposición de los pacientes a múltiples manejos antibióticos, procedimientos invasivos y estudios radiológicos. El objetivo de este estudio es estimar la prevalencia de DVI en la consulta ambulatoria de urología y nefrología pediátrica. Métodos Se evaluó una cohorte prospectiva de 334 pacientes de 5 a 18 años. Se aplicó el cuestionario de Puntuación de Síntomas del Tracto Urinario Inferior (Pediatric Lower Urinary Tract Symptom Score, PLUTSS), cuyo resultado mayor a 8 fue considerado significativo. Adicionalmente, se usó la Escala de Heces de Bristol (Bristol Stool Scale) y los Criterios Roma IV (Rome IV Criteria) para estreñimiento e incontinencia fecal. Los factores de riesgo se evaluaron bajo modelos de regresión logística. Resultados La edad mediana fue de 9 años (rango intercuartil [RIC]: 6­13). El cuestionario PLUTSS fue significativo en 16,5% de los niños, y se observó estreñimiento en 31,9%, e incontinencia fecal en 4%. La prevalencia de DVI fue de 27,8%. El sexo femenino (razón de probabilidades [RP]: 2.47; p = 0.002) y desordenes psicológicos (RP: 4.637; p = 0.024) fueron considerados factores de riesgo. La evaluación del cuestionario PLUTSS mostró relevancia en incontinencia (RP: 3.059; p = 0.038), enuresis (RP: 8.532; p < 0.001), flujo intermitente (RP: 9.211; p = 0.004), frecuencia (RP: 6.73; p = 0.005), y estreñimiento (RP: 34.46; p < 0.001). Conclusiones La prevalencia de DVI fue de 27.8% en la consulta ambulatoria. Es importante prevenir complicaciones asociadas y la exposición a múltiples tratamientos antibióticos, procedimientos invasivos e imagenológicos, que adicionalmente generan altos costos al sistema de salud.