Pathology findings in pediatric patients with COVID-19 and kidney dysfunction

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Acute kidney injury (AKI) is seen in one-fifth of pediatric patients with COVID-19 requiring hospital admission, and is associated with increased morbidity, mortality, and residual kidney impairment. The majority of kidney pathology data in patients with COVID-19 is derived from adult case series and there is an overall lack of histologic data for most pediatric patients with COVID-19. Methods: We assembled a multi-institutional cohort of five unvaccinated pediatric patients with COVID-19 and associated kidney dysfunction with available histology. Results: Three complex patients with current or prior SARS-CoV-2 infection had multifactorial thrombotic microangiopathy with clinical features of hemolytic uremic syndrome (in two) or disseminated intravascular coagulation (in one); one died and another developed chronic kidney disease stage 5. Two with recently preceding SARS-CoV-2 infection presented with nephrotic syndrome; one had IgA vasculitis and one had minimal change disease. Within a short follow-up time, none has returned to baseline kidney function. Conclusion: Although uncommon, COVID-19-associated kidney injury can have significant morbidity in the unvaccinated pediatric and adolescent population. Graphical abstract: A higher resolution version of the Graphical abstract is available as Supplementary information.[Figure not available: see fulltext.].

Original languageEnglish (US)
Pages (from-to)2375-2381
Number of pages7
JournalPediatric Nephrology
Issue number10
StatePublished - Oct 2022


  • AKI
  • Acute kidney injury
  • COVID-19
  • Glomerulonephritis
  • HSP
  • HUS
  • Hemolytic uremic syndrome
  • Henoch-Schönlein purpura
  • IgA vasculitis
  • Kidney biopsy
  • Kidney dysfunction
  • Nephrotic syndrome
  • Proteinuria
  • Renal pathology
  • SARS-CoV-2
  • TMA
  • Thrombotic microangiopathy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology


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