Advanced chronic kidney disease among UK children.

The UK Renal Registry currently collects information on UK children with kidney failure requiring long-term kidney replacement therapy (KRT), which supports disease surveillance and auditing of care and outcomes; however, data are limited on children with chronic kidney disease (CKD) not on KRT. METHODS: In March 2020, all UK Paediatric Nephrology centres submitted data on children aged <16 years with severely reduced kidney function as of December 2019, defined as an estimated glomerular filtration rate <30 mL/min/1.73 m2. RESULTS: In total, 1031 children had severe CKD, the majority of whom (80.7%) were on KRT. The overall prevalence was 81.2 (95% CI 76.3 to 86.3) per million of the age-related population. CONCLUSIONS: The prevalence of severe CKD among UK children is largely due to a high proportion of children on long-term KRT. Expanding data capture to include children with CKD before reaching failure will provide greater understanding of the CKD burden in childhood.

National study on the risks of COVID-19 for paediatric renal transplant recipients

IntroductionFrom the start of the COVID-19 pandemic, evidence emerged that children were less affected by SARS-CoV-2 PCR DNA COVID-19 positive infections, with increasing evidence showing immunosuppressed children were less at risk compared to immunosuppressed adults. The aim of our study was to investigate how COVID-19 infections affected paediatric renal transplant recipients in the UK.MethodsQuestionnaires regarding patient demographics, renal transplant information, COVID-19 infection data and care of patients during the COVID-19 pandemic were sent out to all 13 UK paediatric nephrology centres.Results54 patients (69% male;50% Black, Asian and minority ethnic [BAME];57% living donors) aged 4–19 (median 11) years and between 2 months – 15 years (median 3 years 1 month) post-transplantation from nine centres tested positive for SARS-CoV-2 PCR DNA. Four centres had no positive patients. 48% presented with the classical COVID-19 symptoms (37% fever, 11% continuous cough and 4% loss of sense of taste or smell);atypical presentations included diarrhoea (13%) and headache (8%). 37% of patients were asymptomatic. 28% were hospitalised (median stay 2 days) which included asymptomatic patients admitted for other reasons. Of those admitted, one patient required oxygen;however, no patients required ventilation or intensive care admission. One child had a rejection episode as a complication of the infection and one adolescent had ongoing cardiorespiratory symptoms for six months. There was evidence of AKI with renal transplant dysfunction in 31% of patients, with increase in mean baseline plasma creatinine from 80.6µmol/l to 171.7µmol/l, but no patients required CVVH or dialysis.Conclusion9% of the UK paediatric renal transplantation population have had documented SARS-CoV-2 PCR DNA infections with 28% required hospitalisation. There was increased prevalence of AKI, particularly after the first wave of the COVID-19 pandemic, possibly due to different variants, although there is no specific virological data to support this.

A case series of paediatric kidney transplants during the ongoing COVID-19 pandemic

BackgroundDuring the current COVID-19 pandemic, multiple lockdowns and a high incidence of cases severely impacted many European transplant programs. During the first wave of the pandemic, there was a need to stop both the living donor (LD) and deceased donor (DD) paediatric kidney transplant (KT) programs in our centres, subsequently reopening them fully. In contrast, increased confidence in our processes and outcomes led us to keep our deceased donor paediatric programme open during the UK’s second COVID-19 wave.ObjectivesWe report our experience with 25 children who received a KT during the current ongoing COVID-19 pandemic.MethodsFrom May 2020 to February 2021, all paediatric KT recipients were recorded and followed up in Evelina London Children’s Hospital, Southampton Children’s Hospital and Great Ormond Street Hospital. Covid-secure pathways were established for both LD and recipients following the UK guidelines on COVID-19. We prospectively recorded transplant outcomes and instances of SARS-CoV-2 infection in KT recipients.ResultsThere was 100% patient and 100% renal allograft survival in all 25 (12 (48%) female) KT recipients aged 2 to 17 (median 11) years of whom 18 were from LD (72%) and 7 from DD (28% [5 transplants from donors after brain death and 2 from donors after cardiac death]). Two patients (8%) developed COVID-19;one of them 5 weeks post-KT presenting with low grade fever and high CRP for one week without acute kidney injury during admission for surgical complication. The second one 4 month’s post-KT, presenting with low grade fever without any further complication. Four (16%) transplants were intraperitoneal, with 21 (84%) extraperitoneal, including an en-bloc KT. There were no vascular complications and two ureteric complications requiring surgical intervention. All of the patients shielded as per local guidelines.ConclusionsDuring the COVID-19 pandemic, different strategies had to be taken on the transplant programme to enable paediatric KT programmes to continue. This enabled safe and effective transplantation options from both living and deceased donors. In our experience, two transplant recipients acquired COVID-19 post-transplant without renal allograft dysfunction and did not require any changes to the immunosuppression.