Extreme Hypertension Associated with SARS-COVID-19 Infection in Pediatrics with Kidney Disease: A Retrospective Observational Study

Introduction: There are no reports of hypertensive emergency as a manifestation or comorbidity of the COVID-19 infection in pediatric patients. Method: In this retrospective observational study, we report patients diagnosed with COVID-19 with presentation of acute severe hypertension from March to February, 2021. Confirmed cases were defined by positive reverse transcription-polymerase chain reaction (RT-PCR) of nasopharynx swab, elevated antibody against, or imaging pattern in favor of it on chest CTscan. Hypertensive crisis was elucidated by the acute rise of blood pressure more than stage 2 cut off with the potential risk of end-organ damage. Results: Six confirmed SARS-CoV-2 patients with an average age of 4.2 years old were described. Four patients with recently diagnosed nephrotic syndrome and two with chronic kidney disease who were on orderly dialysis were enrolled without clinical signs of liquid accumulation. The lowest and highest systolic and diastolic blood pressures all along hospitalization was 160-200 mmHg and 100-155 mmHg, respectively. All children had poorly controlled hypertension, managed with Labetalol infusion titrated to maximum dosage, extended for at most seven days, and their blood pressure had been regulated with four or five antihypertensive drugs. Conclusion: It is crucial to consider the COVID-19 diagnosis in a patient displaying a hypertension crisis, even in the absence of classic signs of the virus. We recommend that medical practitioners consider the probability of COVID-19 infection in cases presenting to the hospital with acute severe hypertension.