Diagnostic markers of kidney damage in children with post-COVID-19 syndrome
DOI:
https://doi.org/10.15574/SP.2025.8(152).612Keywords:
children, kidney functional status, post-COVID-19 syndromeAbstract
The SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2) has been showin to adversely affect kidney tissue, causing inflammatory, autoimmune, and metabolic disorders, which pose a risk of developing acute and chronic nephropathies. The lack of clear diagnostic criteria for kidney damage in children with post-COVID-19 syndrome (condition after recovering from COVID-19) complicates timely treatment and prevention of complications. Identifying early diagnostic markers of kidney damage is important for early detection of pathology, which would improve medical surveillance and timely treatment.
Aim - to identify early diagnostic markers of kidney injury in children with post-COVID-19 syndrome.
Materials and methods. This observational study included 30 children under the age of 18 diagnosed with post-COVID-19 syndrome who had documented urinary abnormalities during the acute phase of SARS-CoV-2 infection and were hospitalized between January 2023 and July 2024. The source of information was the "Medical Record of an Inpatient". The study was conducted using a targeted selective screening method. All children underwent comprehensive clinical and laboratory examinations according to generally accepted pediatric standards. The following indicators of kidney functional status were assessed: anti-crystallization capacity of urine (ACCU), daily salt excretion, lipid peroxidation (LPO) products, polar lipids (PL), and a series of urinalysis tests. The study results were compared with data from 40 children in the control group. Statistical analysis was performed using the EZR package (R-statistics).
Results. It was found that the intensity of tissue hypoxia and dysfunction of the proximal nephron segments directly correlates with SARS-CoV-2-induced damage. This is evidenced by a decrease in ACCU towards calcium phosphates, reduced phosphate excretion, increased excretion of LPO products and appearance of PL, as well as a higher frequency of proteinuria and calciuria in urine compared to the control group.
Conclusions. The possibility of predicting and diagnosing post-COVID-19 syndrome in children with urinary tract damage using non-invasive biochemical markers of tissue hypoxia and renal parenchymal membranolysis in children's daily urine has been confirmed.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the study. Informed consent was obtained from the parents and children.
The authors declare no conflict of interest.
References
Avramescu M, Isnard P, Temmam S, Chevalier A, Bastard P, Attia M et al. (2023). Acute tubulointerstitial nephritis with or without uveitis: a novel form of post-acute COVID-19 syndrome in children. Kidney international. 103(6): 1193-1198. https://doi.org/10.1016/j.kint.2023.02.028; PMid:36918081 PMCid:PMC10008186
Cancarevic I, Nassar M, Medina L, Sanchez A, Parikh A, Hosna A et al. (2022). Nephrotic Syndrome in Adult Patients With COVID-19 Infection or Post COVID-19 Vaccine: A Systematic Review. Cureus. 14(9): e29613. https://doi.org/10.7759/cureus.29613
Chou J, Thomas PG, Randolph AG. (2022). Immunology of SARS-CoV-2 infection in children. Nature immunology. 23(2): 177-185. https://doi.org/10.1038/s41590-021-01123-9; PMid:35105983 PMCid:PMC8981222
El-Halaby H, Eid R, Elagamy A, El-Hussiny A, Moustafa F et al. (2024). A retrospective analysis of acute kidney injury in children with post-COVID-19 multisystem inflammatory syndrome: insights into promising outcomes. Italian journal of pediatrics. 50(1): 23. https://doi.org/10.1186/s13052-024-01598-w; PMid:38317228 PMCid:PMC10845792
Felsenstein S, Hedrich CM. (2020). COVID-19 in children and young people. The Lancet. Rheumatology. 2(9): e514-e516. https://doi.org/10.1016/S2665-9913(20)30212-5; PMid:32838308 PMCid:PMC7324116
George S, Pal AC, Gagnon J, Timalsina S, Singh P, Vydyam P et al. (2021). Evidence for SARS-CoV-2 Spike Protein in the Urine of COVID-19 Patients. Kidney360. 2(6): 924-936. https://doi.org/10.34067/KID.0002172021; PMid:35373072
Han X, Ye Q. (2021). Kidney involvement in COVID-19 and its treatments. Journal of medical virology. 93(3): 1387-1395. https://doi.org/10.1002/jmv.26653; PMid:33150973
Jansen J, Reimer KC, Nagai JS, Varghese FS, Overheul GJ, de Beer M et al. (2022). SARS-CoV-2 infects the human kidney and drives fibrosis in kidney organoids. Cell stem cell. 29(2): 217-231.e8. https://doi.org/10.1016/j.stem.2021.12.010; PMid:35032430 PMCid:PMC8709832
Klomjit N, Zand L, Cornell LD, Alexander MP. (2023). COVID-19 and Glomerular Diseases. Kidney international reports. 8(6): 1137-1150. https://doi.org/10.1016/j.ekir.2023.03.016; PMid:37274308 PMCid:PMC10041821
Lippi G, Sanchis-Gomar F, Henry BM. (2023). COVID-19 and its long-term sequelae: what do we know in 2023? Polish archives of internal medicine. 133(4): 16402. https://doi.org/10.20452/pamw.16402
Lopez-Leon S, Wegman-Ostrosky T, Ayuzo Del Valle NC, Perelman C, Sepulveda R et al. (2022). Long-COVID in children and adolescents: a systematic review and meta-analyses. Scientific reports. 12(1): 9950. https://doi.org/10.1038/s41598-022-13495-5; PMid:35739136 PMCid:PMC9226045
Lukyanenko NS, Kens KA, Petritsa NA. (2016). Evaluating the Diagnostic Value of the Tissue Hypoxia, Membrane Destruction and Undifferentiated Connective Tissue Dysplasia Markers in Young Children with Vesicouretheral Reflux. Child's health. 6(74): 86-92. https://doi.org/10.22141/2224-0551.6.74.2016.82138
Lukianenko NS, Kens KA, Petritsa NA. (2016). Renal Parenchymal Hypoxia in Young Children in the Period of Complete Remission of Acute Uncomplicated Pyelonephritis without Renal Impairment. KIDNEYS. 2(16): 33. https://doi.org/10.22141/2307-1257.2.16.2016.72747
Ma L, Mazidi M, Li K, Li Y, Chen S, Kirwan R et al. Z. (2021). Prevalence of mental health problems among children and adolescents during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of affective disorders. 293: 78-89. https://doi.org/10.1016/j.jad.2021.06.021; PMid:34174475 PMCid:PMC9711885
Morello M, Amoroso D, Losacco F, Viscovo M, Pieri M et al. (2023). Urine Parameters in Patients with COVID-19 Infection. Life (Basel, Switzerland). 13(8): 1640. https://doi.org/10.3390/life13081640; PMid:37629497 PMCid:PMC10455209
Nikolopoulou GB, Maltezou HC. (2022). COVID-19 in Children: Where do we Stand? Archives of medical research. 53(1): 1-8. https://doi.org/10.1016/j.arcmed.2021.07.002; PMid:34311990 PMCid:PMC8257427
Piazza M, Di Cicco M, Pecoraro L, Ghezzi M, Peroni D, Comberiati P. (2022). Long COVID-19 in Children: From the Pathogenesis to the Biologically Plausible Roots of the Syndrome. Biomolecules. 12(4): 556. https://doi.org/10.3390/biom12040556; PMid:35454144 PMCid:PMC9024951
Polushkin PM. (2015). Vikova fiziolohiia ta valeolohiia liudyny. Posibnyk do vyvchennia kursu. [Elektronyi tekst]. D.: DNU: 138.
Raina R, Mawby I, Chakraborty R, Sethi SK, Mathur K et al. (2022). Acute kidney injury in COVID-19 pediatric patients in North America: Analysis of the virtual pediatric systems data. PloS one. 17(4): e0266737. https://doi.org/10.1371/journal.pone.0266737; PMid:35472149 PMCid:PMC9041802
Riggioni C, Comberiati P, Giovannini M, Agache I, Akdis M, Alves-Correia M et al. (2020). A compendium answering 150 questions on COVID-19 and SARS-CoV-2. Allergy. 75(10): 2503-2541. https://doi.org/10.1111/all.14449; PMid:32535955 PMCid:PMC7323196
Sokolowska M, Lukasik ZM, Agache I, Akdis CA, Akdis D, Akdis M et al. (2020). Immunology of COVID-19: Mechanisms, clinical outcome, diagnostics, and perspectives-A report of the European Academy of Allergy and Clinical Immunology (EAACI). Allergy. 75(10): 2445-2476. https://doi.org/10.1111/all.14462; PMid:32584441 PMCid:PMC7361752
Su H, Yang M, Wan C, Yi LX, Tang F, Zhu,HY et al. (2020). Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney international. 98(1): 219-227. https://doi.org/10.1016/j.kint.2020.04.003; PMid:32327202 PMCid:PMC7194105
Tang S, Xiang M, Cheung T, Xiang YT. (2021). Mental health and its correlates among children and adolescents during COVID-19 school closure: The importance of parent-child discussion. Journal of affective disorders. 279: 353-360. https://doi.org/10.1016/j.jad.2020.10.016; PMid:33099049 PMCid:PMC7550131
Zhang JJ, Dong X, Liu GH, Gao YD. (2023). Risk and Protective Factors for COVID-19 Morbidity, Severity, and Mortality. Clinical reviews in allergy & immunology. 64(1): 90-107. https://doi.org/10.1007/s12016-022-08921-5; PMid:35044620 PMCid:PMC8767775
Zheng YB, Zeng N, Yuan K, Tian SS, Yang YB, Gao N et al. (2023). Prevalence and risk factor for long COVID in children and adolescents: A meta-analysis and systematic review. Journal of infection and public health. 16(5): 660-672. https://doi.org/10.1016/j.jiph.2023.03.005; PMid:36931142 PMCid:PMC9990879
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Modern pediatrics. Ukraine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
