General COVID-19 updates
Upcoming ISN-IPNA Webinar: ‘COVID-19 and the Kidney: interesting differences and similarities between children and adults’ Wednesday, July 1, 9-10 EST
Registration information: https://register.gotowebinar.com/register/7727495670521621771?source=IPNA
ASN Webinar: AKI: the Kidney/Lung Connection and Fluid Management in COVID-19
Information for Dialysis Centers
Link to ASN dialysis webinar from 4/2/20 (PDF of slide sis also available on this site)
The Children's Hospital Association Hosted a Webinar Presented by the CDC on Preparing Dialysis Units for Covid-19
CDC Dialysis Recommendations: Interim additional guidance for infection prevention and control recommendations for patients with suspected or confirmed COVID-19 in outpatient hemodialysis facilities: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/dialysis.html
American Society of Nephrology- COVID-19 Information for Providers of Dialysis Service- webinar:
Webinar Recording Available: COVID-19 Informational Webinar for Providers of Dialysis Services
On March 11, 2020, ASN conducted an informational webinar focusing on new COVID-19 guidance for dialysis facilities from CDC and a presentation on managing patients with COVID-19 who require dialysis. This 60-minute webinar explored the possible implications for patients receiving renal replacement therapy and the staff who care for them. The webinar featured presentations from Shannon Novosad, MD, of CDC, and Suzanne Watnick, MD, FASN, and Liz McNamara, MN, RN, of Northwest Kidney Centers.
The webinar recording and slides have been posted on the NTDS website, which also has links to all updated materials from CDC.
ASN COVID-19 AKI Webinar (featuring Dr. Goldstein)
Full webinar available at: https://www.asn-online.org/covid-19/
Kidney Transplant Information
From American Society for Transplantation for transplant recipients: Coronavirus disease 2019: frequently asked questions.
American Society of Transplantation: COVID-19: FAQs for Organ Transplantation (geared more towards transplant providers): https://www.myast.org/sites/default/files/COVID19%20FAQ%20Tx%20Centers%20030220-1.pdf
US Department of Health and Human Services: Information for transplant programs and OPOs regarding 2019 novel Coronavirus: https://optn.transplant.hrsa.gov/news/information-for-transplant-programs-and-opos-regarding-2019-novel-coronavirus/
Association of organ procurement organizations: COVID-19 bulletin (information regarding organ procurement) https://www.aopo.org/information-about-covid-19-coronavirus-is-being-released-rapidly-we-will-post-updates-as-we-receive-them/
Please see the UNOS website for updates regarding making patients temporarily inactive due to COVID-19, and temporarily inactivating your program’s waiting less if you will be unable to provide transplant services in the coming weeks or months
American Society of Transplant Surgeons COVID-19 Strike Force (recommendations surrounding prioritizing transplants)
Research and Commentary Articles
Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China (Dong at al, Pediatrics)
Successful recovery of covid-19 pneumonia in a renal transplant recipient with long-term immunosuppression (only 1 adult patient, but there is very limited data on this topic)
Epidemiology and Clinical Features of Coronavirus 2019 in Children, Choi et al, Clinical and Experimental Pediatrics
Kidney Disease in the Time of COVID-19: Major challenges to Patient Care, Rabb, The Journal of Clinical Investigation
Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19, Vaduganathan et al, NEJM
Coronavirus Disease 2019 (COVID-19) Infection and Renin Angiotensin System Blockers, Bavishi C et al, JAMA Cardiology
Hydroxychloroquine and Azithromycin as a Treatment of COVID-19: Results of an Open-Label Non-Randomized Clinical Trial, Gautret P et al. International Journal of Antimicrobial Agents
Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19), A review, Sanders et al, JAMA
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systemic Review. Castagnoli et al, JAMA Pediatrics
How COVID-19 has Changed the Management of Glomerular Diseases. Bomback et al, CJASN
Children with Covid-19 in Pediatric Emergency Departments in Italy- Parri et al, NEJM
Resources for Return to School
Collections of Articles
Research Projects that are Enrolling COVID-19 Positive Pediatric Nephrology Patients
Research project through ERKNet on behalf of Dr. Kjell Tullus and Dr. Marina Vivarelli
We have launched a global study where we invite all paediatric nephrologist in the world to include data from anonymized children with COVID-19.
From Dr. McBryde at the NIH:
This is another de-idenitfied registry of children with COVID-19:
‘The website for the registry is: https://www.pedscovid19registry.com/. The site contains information on the provision of de-identified data, IRB oversight, and case report forms for data submission. There are, I believe, information related to authorship guidelines, as well.
While the data is heavily focused on pediatric malignancies, the data collection form does include children who are immunosuppressed and have a number of organ system diseases, including renal disorders. Hopefully, this registry will be a good first step to describing COVID-19 in pediatric patients, and provide some hypothesis generation for future investigations into specific disorders and medication exposures.
ASPN Workforce Committee Webinar: Telemedicine - Covid-19 Updates, March 26, 2020
- Sample Language & Sample Physical Exam for Telehealth Visits
- Relevant Video from the American Academy of Pediatrics regarding Telehealth and Covid-19
- Telemedice Best Practices from Riley Children's Hospital
AAP Webinar on Telehealth (19 minutes):
General Workforce Issues
AAP CME Offer: In the midst of the COVID-19 crisis, the AAP is expanding its online education to all members. Pedialink, the AAP's online education portal, is offering all courses free of charge to all levels of membership for the time being. Login at Pedialink. On the Continuing Education tab, go to CME Finder and choose online courses. Any member can choose a course from this list where they can register through ShopAAP at no charge.
Recommendations for home BP monitoring (with many thanks to Dr. Tammy Brady):
Each of the following 3 home devices has strengths and weaknesses, but all were tested in children and passed the testing. Information about the validation testing is below
Welch Allyn ProBP2000: tested in 35 children as part of a larger study, used K4 as diastolic
Omron: tested in almost 200 children, but the participants were normotensive and the validation protocol used was less stringent
A&D: tested in 85 children with a reasonable protocol, grade B for SBP, grade A for DBP
This video describes preparing an individual for blood pressure measurement:
Patient and family handouts from the Action learning Network (primarily focused towards children with heart disease or heart transplant, but very relevant to children with kidney disease)
Clinical Affairs & Practice Management Committee: Position Statement on COVID-19 and ACE Inhibitor and Angiotensin Receptor Blocker Use in Children with Hypertension and Kidney Disease
March 16th, 2020
The purpose of this statement is to clarify what is known about the potential risks, if any, to pediatric nephrology patients from treatment with ACE inhibitors or angiotensin receptor blockers (ARBs). As with the original SARS-CoV, the ACE2 enzyme has been confirmed as the SARS-CoV-2 binding site in the lungs1. ACE2 is an important part of the renin-angiotensin-aldosterone system2,3, thus there has been recent speculation that patients who take ACE inhibitors and ARBs may be at increased risk of the infection and COVID-19. However, this is solely based on experimental studies in animals showing increased ACE2 expression in several organs, and there is additional experimental evidence based upon SARS-CoV and other models of acute lung injury that these medications may actually lessen severity of COVID-194. There is currently no evidence that patients on these medications are at a higher risk of SARS-CoV-2 or COVID-19. Indeed, stopping ACE inhibitors and ARBs without good medical evidence can have significant health consequences for our patients.
Many health care providers, patients, and their families are understandably worried about continuing to use these medications during the pandemic. At this time, in line with the Position Statements from other hypertension, cardiovascular, and kidney organizations and after weighing the risks and benefits, the American Society of Pediatric Nephrology strongly recommends that patients continue to take their ACE inhibitors and ARBs, until new evidence to the contrary becomes available. We further recommend that appropriate medical management continue to be provided to patients on these medications who test positive for SARS-CoV-2 and those who have COVID-19, including discontinuation of ACE inhibitors and ARBs when medically indicated. The American Society of Pediatric Nephrology via the Clinical Affairs & Practice Management Committee will continue to work diligently to monitor this evolving situation and to inform its members, partners, and patients and their families of updated recommendations on this important topic. We fully support the ongoing research efforts into this important question and encourage the inclusion of children in such clinical trials or observational studies.
1Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell 2020; ePub; doi: 10.1016/j.cell.2020.02.052
2Simoes e Silva AC, Flynn JT. The renin-angiotensin-aldosterone system in 2011: role in hypertension and chronic kidney disease. Pediatr Nephrol 2012; 27:1835-1845
3South AM, Shaltout HA, Washburn LK, et al. Fetal programming and the angiotensin-(1-7) axis: a review of the experimental and clinical data. Clinical Science 2019; 133:55-74
4Kuba K, Imai Y, Rao S, et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury. Nat Med 2005;11:875-9
European Society of Cardiology Council on Hypertension
European Society of Hypertension
Canadian Cardiovascular Society and the Canadian Heart Failure Society
The Renal Association, UK
The International Society of Hypertension