Projects

Identifying the appropriate patient groups who will benefit most from shielding (strict social distancing/isolation) during the COVID-19 pandemic is important for children as the mental health sequel of shielding are not inconsequential.1,2 Studies have indicated that elderly and adults with associated co-morbidities (hypertension, diabetes, chronic kidney disease and immunosuppressant drugs) are at higher risk in comparison to children.3 In contrast to adults where concomitant immunosuppression has been found to worsen the outcome of SARS-CoV-2 infection3,4 paediatric systematic reviews have concluded that SARS-CoV-2 infections occur in low numbers among immunocompromised children and overall have a favourable outcome.3,5 Literature is limited on the impact of SARS-CoV-2 infection among children with kidney disorders who are on potent immunosuppressant.6–8 Rituximab (B-lymphocyte depleting monoclonal antibody) is one such potent immunosuppressant frequently used in childhood difficult to treat nephrotic syndrome (cDNS) including steroid-dependent nephrotic syndrome (SDNS) and steroid-resistant nephrotic syndrome (SRNS).9 Medical literature on its use during the COVID-19 pandemic is scarce and safety remains a concern.7,8 With this perspective we undertook a questionnaire-based study to evaluate the effect of COVID-19 pandemic on the use of rituximab for cDNS (≤18 years) and assess short-term outcomes among those testing positive for SARS-CoV-2 after receiving rituximab during the pandemic.