Page 328 - Abstract Book KONIKA 18

Nephrology

P-NEP-019
Acute Kidney Injury with COVID-19 and Multisystem Inflammatory Syndrome
in Children in Paediatric Patient Receiving Haemodialysis Treatment:
A Case Report

Valerie Michaela W. , Audya Pratiwi P. R. , Siti Budiati W. 3
2,3
1,3
Faculty of Medicine, Universitas Katolik Atma Jaya, Jakarta and Universitas Lampung, Lampung ,
1
2
Simprug Modular Extension of Pertamina Central Hospital , Jakarta, Indonesia
3
Abstract
Background Acute Kidney Injury (AKI) is a common complication in adults with COVID-19. Despite
numerous studies in the adult population, there are limited data describing AKI in paediatric patients with
COVID-19. We may associate AKI manifestation in children with covid with Multisystem Inflammatory
Syndrome in Children (MIS-C). Objective To describe related clinical characteristics and short-term outcomes
of haemodialysis therapy in AKI with COVID-19. Case A 16-year-old male patient with no significant past
medical history admitted to Intensive care COVID-19 unit with dyspnoea, abdominal pain, diarrhoea and
delirium. The patient was confirmed to have COVID-19 by nasopharyngeal swab PCR and was found to
be in acute kidney injury. On admission, the creatinine level was 8.5 mg/dL with ureum levels of 152 mg/
dL. We also found a significant elevation of inflammatory markers and patient was subsequently diagnosed
with multisystem inflammatory syndrome in children (MIS-C) because of multiorgan involvement including
renal, gastrointestinal, hepatic and hematologic. Mental status and renal function continued to worsen in the
first few days of hospitalization. The patient received haemodialysis. Patient had remarkable improvement in
clinical status and laboratory findings after dialysis and continued to do well throughout the rest of hospital
course and tested negative on nasopharyngeal swab on the 6th day of treatment. Conclusion AKI is a severe
complication of COVID-19 among paediatric patients. Clinician must be aware of broad manifestation of
the new disease entity of COVID-19 and MIS-C, as it can make the diagnosis and management challenging
during a pandemic in limited testing.
Keywords: acute kidney injury; COVID-19; paediatric; haemodialysis

P-NEP-020
Renal Osteodystrophy with Vitamin D Deficiency in Chronic Kidney Disease:
A Case Report

Welas Bestari, Rosmayanti S Siregar, Oke R Ramayani
Department of Child Health, Faculty of Medicine Universitas Sumatera Utara, Adam Malik General Hospital,
Medan, North Sumatera, Indonesia

Abstract
Background Kidney plays an important role in the mineral metabolism as being a target organ for various
hormones. Disorder of bone regulation and mineral metabolism in CKD may lead to renal osteodystrophy and
result in fractures, skeletal deformities, and poor growth. Objective To present a case of renal osteodystrophy
with vitamin D deficiency in patient with CKD. Case A 16-year-old girl came with deformity of lower
leg turn inward causing the appearance of the knees to be touching while the ankles remain apart. She
also complained weakness and bone pain since 4 months ago especially when walking and stair climbing.
Genu X-ray result was bilateral genu valgus with osteoporosis and bone age result was average girl with
osteoporosis. BMD measurement showed the bone density was lower than other 16 years old girl in Asia.
Laboratory results were vitamin D 8.8 ng/ml, calcium 5.6 mg/dL, ureum 272 mg/dL, creatinine 13.6 mg/dL.
Patient was diagnosed with stage V CKD. She got haemodialysis and 4000 IU vitamin D for two months
then 400 IU vitamin D and 400 mg of calcium daily. Patient got her normal level of vitamin D in 2 months
after treatment with calcium 6.8 mg/dL, P 8.3 mg/dL, PTH 1630 pg/mL and was treated with Sevelamer,
educate for low phosphor diet, and follow up in 6 months after treatment. Conclusion Early diagnosis and
management is important to improve the quality of life in patients with CKD.
Keywords: renal, osteodystrophy; bone, mineral density; vitamin D; CKD

280 KONIKA XVIII Abstract Book