Analysis Finds Children Have Elevated Kidney, Heart Risks Years After COVID-19 Infection

Long COVID can result in heightened risks for chronic organ disease among children, even years after the infection, according to researchers from the Perelman School of Medicine at the University of Pennsylvania. These risks include health problems affecting the kidney, gut, and cardiovascular system, investigators said.¹

Problems affect the kidney, gut, and cardiovascular system | Image credit: Monkey Business | stock.adobe.com

“While most public attention has focused on the acute phase of COVID-19, our findings reveal children face significant long-term health risks that clinicians need to monitor,” senior author Yong Chen, PhD, said in a news release.²

In a retrospective cohort study, researchers used data from 19 health institutions in the National Institutes of Health Researching COVID to Enhance Recovery (RECOVER) initiative from March 1, 2020, to May 1, 2023. Participants included children and adolescents younger than 21 years old with at least 1 baseline visit (24 months to 7 days before the index date) and at least 1 follow-up visit (28-179 days after the index date).¹

Kidney Risks

The researchers compared kidney-related outcomes in the post-acute phase among those who had positive SARS-CoV-2 tests to outcomes in individuals who had negative tests and no documented infection during the study period. According to the analysis, children and adolescents with positive SARS-CoV-2 tests had a 17% higher risk of developing stage 2 or higher chronic kidney disease, defined as mild kidney damage that still functions well. These patients also had a 35% higher risk of chronic kidney disease at stage 3 or higher, indicating mild to severe damage impacting kidney function.¹

Furthermore, individuals with pre-existing chronic kidney disease who had a positive SARS-CoV-2 test had a 15% higher risk of developing any of several other kidney-related adverse outcomes, including a major decline in kidney filtration rate, dialysis, or kidney transplant. Children with a documented kidney injury during the acute infection phase also had a 29% higher risk of adverse kidney outcomes 3 to 6 months after infection compared with those with no acute kidney injury.¹

Gastrointestinal Risks

In another study, with findings published in JAMA Network Open, investigators examined gastrointestinal conditions such as abdominal pain, diarrhea, and irritable bowel syndrome among 1,576,933 children and adolescents. Compared with those with a negative SARS-CoV-2 test, individuals with a positive test had a 25% higher risk of developing at least 1 gastrointestinal symptom or disorder in the post-acute phase. They also had a 28% higher risk in the chronic phase from 6 months to 2 years after the SARS-CoV-2 test.³

Cardiovascular Risks

Finally, in study findings published in Nature Communications, investigators found that children and adolescents with SARS-CoV-2 infections had significantly higher risks of developing 1 or more cardiovascular conditions, including arrhythmias, heart inflammation, chest pain, palpitations, and hypertension. These risks were higher regardless of whether the patient had a congenital heart defect (CHD).⁴

Although children with CHDs did have higher absolute risks, the SARS-CoV-2–associated relative increase in risk of developing cardiovascular conditions was consistent (63% increase) across both those with and without CHDs. However, among those without CHD, the risk of heart inflammation in the post-acute phase of infection was nearly tripled compared to those without a SARS-CoV-2 infection.⁴

Racial and Ethnic Disparities

Researchers did identify some differences in post-acute outcomes for study participants in different racial and ethnic groups. For instance, Asian American Pacific Islander (AAPI) children and adolescents had mildly higher rates of developing any long-COVID outcomes in the post-acute phase after severe or non-severe COVID-19 compared with non-Hispanic White children. Additionally, Hispanic patients had a higher risk of hair loss after severe COVID-19 infection, whereas non-Hispanic Black patients had a slightly lower risk of long COVID skin symptoms after severe infection.^2,4

“Overall, these findings underscore the fact that clinicians need to monitor pediatric patients for long COVID signs and symptoms—and need to be prepared to treat these conditions,” Chen said in the news release.²

REFERENCES

1. Li L, Zhou T, Lu Y, et al. Kidney function following COVID-19 in children and adolescents. JAMA Netw Open. 2025;8(4):e254129. doi:10.1001/jamanetworkopen.2025.4129

2. Children face elevated kidney, heart, and gut risks for years after COVID infection. News release. Penn Medicine News. April 21, 2025. Accessed April 25, 2025. https://www.pennmedicine.org/news/news-releases/2025/april/children-face-elevated-health-risks-for-years-after-covid

3. Zhang D, Stein R, Lu Y, et al. Pediatric gastrointestinal tract outcomes during the postacute phase of COVID-19. JAMA Netw Open. 2025;8(2):e2458366. doi:10.1001/jamanetworkopen.2024.58366

4. Zhang B, Thacker D, Zhou T, et al. Cardiovascular post-acute sequelae of SARS-CoV-2 in children and adolescents: cohort study using electronic health records. Nature Communications. 2025;16:3445. doi:10.1038/s41467-025-56284-0