Guidance on COVID-19 for Pediatric Kidney Disease Patients

We know there are a myriad of questions surrounding COVID-19 and pediatric kidney disease during this unpredictable and unprecedented time. The follow list of FAQs were put together on March 12, 2020, in consultation with various NephCure Specialists who focus specifically on pediatric nephrology, to help you and your child maneuver through this pandemic in the safest possible way. As always, please consult with your nephrologist for specific guidance for your child.

1. Should parents pull their immunocompromised children from school?

• • Monitor the information from the CDC on COVID-19, as well as your local hospital’s website. These are your best sources of up-to-date information given the changing situation and variation in different locations.
  • Doctors are currently most concerned about transplant recipients, dialysis patients, and children receiving moderate to high doses of immunosuppression, though we don’t know really know much about the increase in risk just yet.
  • The situation is changing rapidly, and many schools are already closing.
  • If your child’s school is currently open, you can generally send your child to school.
  • If your child has recently undergone a transplant and is on high-dose immunosuppressants, he/she should probably stay home for now.
  • As always, speak with your child’s nephrologist for specific instructions. They are an excellent source of information if you have ongoing questions.
  • This situation is changing day-to-day, and this guidance may quickly become outdated.
  • A good general rule is to follow the advice from the CDC that’s been issued for the elderly.
  • Also check your local government’s website for information that may be more specific to your region.

2. Should patients stop taking their immunosuppressants?

• • You should never stop your child’s immunosuppressant medications unless you speak with your child’s nephrologist.
  • Stopping medications can lead to rejection of a transplant or relapse of Nephrotic Syndrome.
  • There may be rare situations where the immunosuppressive medications can be reduced or stopped, however please consult with your nephrologist first.

3. How can patients who must go to a hospital or other center for treatment (like dialysis, plasmapheresis, etc.) protect themselves from exposure?

• • Practice the general recommendations to limit spread: Handwashing, limit face touching, limit touching public surfaces (like handrails), stay away from other people as much as possible, etc.
  • Pediatric-only centers will be better, if possible.
  • Minimize sitting in waiting rooms and time spent in hospitals as much as possible.
  • Clinics and dialysis centers have most likely developed plans to deal with the spread of COVID-19, including enhanced screening, separating patients into risk groups, etc. Routine medical center visits are probably safer than urgent care or emergency room visits.

4. When should parents call their child’s doctor?

• • In general, you should call for the same issues that would typically prompt you to call your nephrologist.
  • COVID-19 may cause pneumonia and heart problems so call immediately if your child develops respiratory symptoms beyond a mild cough.
  • It is best to call your doctor first, but you may need to take your child to urgent care or the emergency room if the symptoms develop rapidly and are concerning.
  • Symptoms of COVID-19 infections are similar to those of a lower respiratory infection. Use the following guidance to determine whether or not your child needs medical care:
    • Respiratory symptoms beyond a mild cough: difficulty breathing, rapid or deep breathing, or a severe cough
    • Shortness of breath from continued coughing
    • Refusing liquids with decreased urine frequency
    • Crying without ability to be consoled
    • Fever that is not responsive to fever reducing medications
    • Behavior that is not normal for your child
  • Bringing your child to an ER or urgent care “to get tested” or for minor symptoms is currently not recommended since many sites are not offering testing and there is a risk of exposure to COVID-19 and other serious infections.

These recommendations are and will remain fluid. For the most up-to-date information, reference your local hospital’s website, your local government’s website, and guidelines from the CDC for high risk populations and children.

These guidelines were generated on March 12, 2020, in consultation with:

Larry Greenbaum, MD, PhD, Emory University
Sangeeta Hingorani, MD, MPH, Seattle Children’s Hospital
Elaine Kamil, MD, Cedars Sinai Medical Center
Frederick Kaskel, MD, PhD, FASN, Children’s Hospital at Montefiore
Kenneth Lieberman, MD, Hackensack University Medical Center
Joshua J. Zaritsky, MD, PhD, AI duPont Hospital for Children