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Pediatr Nephrol ; 37(9): 1967-1980, 2022 09.
Article in English | MEDLINE | ID: covidwho-1971713


The syndrome of thrombotic microangiopathy (TMA) is a clinical-pathological entity characterized by microangiopathic hemolytic anemia, thrombocytopenia, and end organ involvement. It comprises a spectrum of underlying etiologies that may differ in children and adults. In children, apart from ruling out shigatoxin-associated hemolytic uremic syndrome (HUS) and other infection-associated TMA like Streptococcus pneumoniae-HUS, rare inherited causes including complement-associated HUS, cobalamin defects, and mutations in diacylglycerol kinase epsilon gene must be investigated. TMA should also be considered in the setting of solid organ or hematopoietic stem cell transplantation. In this review, acquired and inherited causes of TMA are described with a focus on particularities of the main causes of TMA in children. A pragmatic approach that may help the clinician tailor evaluation and management is provided. The described approach will allow for early initiation of treatment while waiting for the definitive diagnosis of the underlying TMA.

Hematopoietic Stem Cell Transplantation , Hemolytic-Uremic Syndrome , Purpura, Thrombotic Thrombocytopenic , Thrombotic Microangiopathies , Child , Complement System Proteins , Hemolytic-Uremic Syndrome/etiology , Hemolytic-Uremic Syndrome/genetics , Humans , Purpura, Thrombotic Thrombocytopenic/diagnosis , Thrombotic Microangiopathies/diagnosis , Thrombotic Microangiopathies/etiology , Thrombotic Microangiopathies/therapy
Saudi J Kidney Dis Transpl ; 32(1): 218-222, 2021.
Article in English | MEDLINE | ID: covidwho-1278584


Underlying comorbid illness is a known risk factor for severe coronavirus disease-2019 (COVID-19). Clinical course of COVID-19 in children with primary kidney disease is not well understood. We present the clinical profile and management of COVID-19 in three children at a COVID hospital in India. These children had nephrotic syndrome, hemolytic uremic syndrome, and chronic kidney disease, respectively. The first two were immunosuppressed, mandating to stop their immunosuppressive medications temporarily. Both had mild course of illness. Third child presented with respiratory distress requiring oxygen support, falling into moderate disease. Renal functions were normal in all of them. They all responded well to oral azithromycin and supportive management. None of them received chloroquine, corticosteroids, or monoclonal antibodies. All three recovered without complications.

COVID-19/complications , COVID-19/therapy , Hemolytic-Uremic Syndrome/complications , Nephrotic Syndrome/complications , Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , Child , Child, Preschool , Female , Hemolytic-Uremic Syndrome/drug therapy , Humans , Immunosuppressive Agents/therapeutic use , Male , Nephrotic Syndrome/drug therapy , Oxygen Inhalation Therapy , SARS-CoV-2