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Background <p>Idiopathic nephrotic syndrome (INS) is the most common kidney disease in children; however, the characteristics of kidney involvement, which occurs following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with INS, remain unclear. Therefore, in the present study, we investigated the clinical characteristics of children with INS infected with SARS-CoV-2.</p> Methods <p>We retrospectively enrolled 20 children with INS infected with SARS-CoV-2, and 50 without underlying diseases infected during the same period as controls. Data on sex, age, mode of transmission, vaccination status, duration of illness, clinical symptoms, myocardial enzyme levels, D-dimer levels, kidney function, incidence of acute kidney injury (AKI), respiratory support, immunoglobulin levels, and absolute lymphocyte values were collected and compared between the groups. Information regarding the type of pathology, immunosuppressant use, and time of relapse in the INS group was also collected.</p> Results <p>In the INS group, 10 patients had a history of intrafamilial transmission. All cases had mild symptoms, mostly cough and fever, with an average disease duration of 1 week. The two groups showed no significant differences in sex, age, mode of transmission, vaccination, duration of illness, clinical symptoms, elevated D-dimer level, AKI, or respiratory support. A significant difference was observed only in myocardial enzyme elevations (<i>P</i>&lt;0.001<sup><i>b</i></sup>). Overall, six children with steroid-sensitive nephrotic syndrome relapsed, but all achieved remission by steroid upregulation. Kidney function deteriorated in two patients, while one developed AKI. Two patients developed new-onset INS. During SARS-CoV-2 infection, IgA levels were significantly increased in the INS group compared to that in the control group. IgA and IgM levels in INS group gradually increased before, during, and after infection, with significant differences.</p> Conclusions <p>SARS-CoV-2 infections in children with INS were mainly intrafamilial, and mostly mild. SARS-CoV-2 infection was associated with relapse in INS, and may lead to complications such as myocardial enzyme elevations, AKI, deterioration of kidney function, while upregulated steroid therapy might be effective in relapse cases of children with SSNS. Further, we found that healthy children are at risk of new-onset INS following SARS-CoV-2 infection.</p>

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Clinical characteristics of children with idiopathic nephrotic syndrome infected with SARS-CoV-2: a single-center retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2025年10月10日

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  • Li-E Wu,
  • Jun-Yu Wei,
  • Zi-Hui Lin,
  • Hong-Chao Li,
  • Chun-Lin Huang

摘要

Background

Idiopathic nephrotic syndrome (INS) is the most common kidney disease in children; however, the characteristics of kidney involvement, which occurs following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with INS, remain unclear. Therefore, in the present study, we investigated the clinical characteristics of children with INS infected with SARS-CoV-2.

Methods

We retrospectively enrolled 20 children with INS infected with SARS-CoV-2, and 50 without underlying diseases infected during the same period as controls. Data on sex, age, mode of transmission, vaccination status, duration of illness, clinical symptoms, myocardial enzyme levels, D-dimer levels, kidney function, incidence of acute kidney injury (AKI), respiratory support, immunoglobulin levels, and absolute lymphocyte values were collected and compared between the groups. Information regarding the type of pathology, immunosuppressant use, and time of relapse in the INS group was also collected.

Results

In the INS group, 10 patients had a history of intrafamilial transmission. All cases had mild symptoms, mostly cough and fever, with an average disease duration of 1 week. The two groups showed no significant differences in sex, age, mode of transmission, vaccination, duration of illness, clinical symptoms, elevated D-dimer level, AKI, or respiratory support. A significant difference was observed only in myocardial enzyme elevations (P<0.001b). Overall, six children with steroid-sensitive nephrotic syndrome relapsed, but all achieved remission by steroid upregulation. Kidney function deteriorated in two patients, while one developed AKI. Two patients developed new-onset INS. During SARS-CoV-2 infection, IgA levels were significantly increased in the INS group compared to that in the control group. IgA and IgM levels in INS group gradually increased before, during, and after infection, with significant differences.

Conclusions

SARS-CoV-2 infections in children with INS were mainly intrafamilial, and mostly mild. SARS-CoV-2 infection was associated with relapse in INS, and may lead to complications such as myocardial enzyme elevations, AKI, deterioration of kidney function, while upregulated steroid therapy might be effective in relapse cases of children with SSNS. Further, we found that healthy children are at risk of new-onset INS following SARS-CoV-2 infection.