Acute Kidney Injury in Critically Ill Children: A Retrospective Analysis of Risk Factors

2019 ◽  
Vol 49 (1-2) ◽  
pp. 1-7 ◽  
Author(s):  
Francesca De Zan ◽  
Angela Amigoni ◽  
Roberta Pozzato ◽  
Andrea Pettenazzo ◽  
Luisa Murer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Significant Risk ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Critically Ill Children ◽  
Multiple Organ Dysfunction ◽  
Risk Of Mortality ◽  
Nephrotoxic Drugs

Introduction: Children admitted to paediatric intensive care unit (PICU) are at risk of acute kidney injury (AKI). However, few paediatric studies have focused on the identification of factors potentially associated with the development of this condition. The aim of our study was to assess the incidence rate of AKI, identify risk factors, and evaluate clinical outcome in a large sample of critically ill children. Methods: This retrospective observational study was conducted including patients admitted to our PICU from January 2014 to December 2016. AKI was defined according to Kidney Disease: Improving Global Outcome criteria. Results: A total of 222 PICU patients out of 811 (27%) had AKI (stage I 39%, stage II 24%, stage III 37%). The most common PICU admission diagnoses in AKI cases were heart disease (38.6%), respiratory failure (16.8%) and postsurgical non-cardiac patients (11%). Hypoxic-ischaemic was the most frequent cause of AKI. Significant risk factors for AKI following multivariate analysis were age >2 months (OR 2.43; 95% CI 1.03–7.87; p = 0.05), serum creatinine at admission >44 µmol/L (OR 2.23; 95% CI 1.26–3.94; p = 0.006), presence of comorbidities (OR 1.84; 95% CI 1.03–3.30; p = 0.04), use of inotropes (OR 2.56; 95% CI 1.23–5.35; p= 0.012) and diuretics (OR 2.78; 95% CI 1.49–5.19; p = 0.001), exposure to nephrotoxic drugs (OR 1.66; 95% CI 1.01–2.91; p= 0.04), multiple organ dysfunction syndrome (OR 2.68; 95% CI 1.43–5.01; p = 0.002), and coagulopathy (OR 1.89; 95% CI 1.05–3.38, p = 0.03). AKI was associated with a significant longer PICU stay (median LOS of 8 days, interquartile range [IQR] 3–16, versus 4 days, IQR 2–8, in non-AKI patients; p < 0.001). The mortality rate resulted tenfold higher in AKI than non-AKI patients (12.6 vs. 1.2%; p < 0.001). Conclusions: The incidence of AKI in critically ill children is high, with an associated increased length of stay and risk of mortality. In the PICU setting, risk factors of AKI are multiple and mainly associated with illness severity.

Risk Factors of Acute Kidney Injury in Critically Ill Children*

2016 ◽  
Vol 17 (9) ◽  
pp. e391-e398 ◽  
Author(s):  
Morgan B. Slater ◽  
Andrea Gruneir ◽  
Paula A. Rochon ◽  
Andrew W. Howard ◽  
Gideon Koren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Children

Incidence, Risk Factors, the Role of Plasma NGAL and Outcome of Contrast-Induced Acute Kidney Injury in Critically Ill Children

2020 ◽  
Vol 88 (1) ◽  
pp. 34-40
Author(s):  
Yamini Agarwal ◽  
Ramachandran Rameshkumar ◽  
Sriram Krishnamurthy ◽  
Gandhipuram Periyasamy Senthilkumar
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Plasma Ngal ◽  
Incidence Risk

scholarly journals Early Diagnosis and Prognostic Value of Acute Kidney Injury in Critically Ill Patients

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 506
Author(s):  
Diana Dobilienė ◽  
Jūratė Masalskienė ◽  
Šarūnas Rudaitis ◽  
Astra Vitkauskienė ◽  
Jurgita Pečiulytė ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Critically Ill ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Critically Ill Children ◽  
Multiple Organ Dysfunction ◽  
Organ Systems ◽  
Patient Groups ◽  
The Mean

Background and objectives: In hospitalized children, acute kidney injury (AKI) remains to be a frequent and serious condition, associated with increased patient mortality and morbidity. Identifying early biomarkers of AKI and patient groups at the risk of developing AKI is of crucial importance in current clinical practice. Specific human protein urinary neutrophil gelatinase-associated lipocalin (uNGAL) and interleukin 18 (uIL-18) levels have been reported to peak specifically at the early stages of AKI before a rise in serum creatinine (sCr). Therefore, the aim of our study was to determine changes in uNGAL and uIL-18 levels among critically ill children and to identify the patient groups at the highest risk of developing AKI. Materials and methods: This single-center prospective observational study included 107 critically ill children aged from 1 month to 18 years, who were treated in the Pediatric Intensive Care Unit (PICU) of Lithuanian University of Health Sciences Hospital Kauno Klinikos from 1 December 2013, to 30 November 2016. The patients were divided into two groups: those who did not develop AKI (Group 1) and those who developed AKI (Group 2). Results: A total of 68 (63.6%) boys and 39 (36.4%) girls were enrolled in the study. The mean age of the patients was 101.30 ± 75.90 months. The mean length of stay in PICU and hospital was 7.91 ± 11.07 and 31.29 ± 39.09 days, respectively. A total of 32 (29.9%) children developed AKI. Of them, 29 (90.6%) cases of AKI were documented within the first three days from admission to hospital. In all cases, AKI was caused by diseases of non-renal origin. There was a significant association between the uNGAL level and AKI between Groups 1 and 2 both on day 1 (p = 0.04) and day 3 (p = 0.018). Differences in uNGAL normalized to creatinine in the urine (uCr) (uNGAL/uCr) between the groups on days 1 and 3 were also statistically significant (p = 0.007 and p = 0.015, respectively). uNGAL was found to be a good prognostic marker. No significant associations between uIL-18 or Uil-18/uCr and development of AKI were found. However, the uIL-18 level of >69.24 pg/mL during the first 24 h was associated with an eightfold greater risk of AKI progression (OR = 8.33, 95% CI = 1.39–49.87, p = 0.023). The AUC for uIL-18 was 73.4% with a sensitivity of 62.59% and a specificity of 83.3%. Age of <20 months, Pediatric Index of Mortality 2 (PIM2) score of >2.5% on admission to the PICU, multiple organ dysfunction syndrome with dysfunction of three and more organ systems, PICU length of stay more than three days, and length of mechanical ventilation of >five days were associated with a greater risk of developing AKI. Conclusions: Significant risk factors for AKI were age of <20 months, PIM2 score of >2.5% on admission to the PICU, multiple organ dysfunction syndrome with dysfunction of 3 and more organ systems, PICU length of stay of more than three days, and length of mechanical ventilation of > five days. uNGAL was identified as a good prognostic marker of AKI. On admission to PICU, uNGAL should be measured within the first three days in patients at the risk of developing AKI. The uIL-18 level on the first day was found to be as a biomarker predicting the progression of AKI.

scholarly journals Acute kidney injury in critically ill children: Risk factors and outcomes

2014 ◽  
Vol 18 (3) ◽  
pp. 129-133 ◽  
Author(s):  
Jyoti Sharma ◽  
Shweta Naik ◽  
Rameshwor Yengkom ◽  
Vijay Kalrao ◽  
Atul Mulay
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Children

Drugs as risk factors of acute kidney injury in critically ill children

2015 ◽  
Vol 31 (1) ◽  
pp. 145-151 ◽  
Author(s):  
Corina Glanzmann ◽  
Bernhard Frey ◽  
Priska Vonbach ◽  
Christoph R. Meier
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Children

Incidence, risk factors and outcome of acute kidney injury in critically ill children – a developing country perspective

2016 ◽  
Vol 37 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Rashi Singal Rustagi ◽  
Kamaldeep Arora ◽  
Rashmi Ranjan Das ◽  
Puneet Aulakh Pooni ◽  
Daljit Singh
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Developing Country ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Incidence Risk

scholarly journals Profile and outcome of acute kidney injury in critically ill children admitted to pediatric intensive care unit

2018 ◽  
Vol 5 (6) ◽  
pp. 2148
Author(s):  
Urmila Chauhan ◽  
Yogesh Phirke ◽  
Sandeep Golhar ◽  
Abhishek Madhura
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Serum Creatinine ◽  
Critically Ill ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Nephrotoxic Drugs

Background: Acute kidney injury (AKI) is defined as an abrupt onset of renal dysfunction resulting from injurious endogenous or exogenous processes characterized by a decrease in glomerular filtration rate (GFR) and an increase in serum creatinine. AKI is common in critically ill children and early diagnosis is important for better outcome in these children.Methods: This was a prospective observational study. Critically ill infants and children of either sex and in age group between >28 days to 12 years admitted to pediatric intensive care unit (PICU) were included. Serum creatinine and estimated creatinine clearance (eCC) were used to and patients classified as AKI on pRIFLE criteria either at admission or subsequently during the hospital stay. AKI cases were further classified into risk, injury or failure category on the day of development of AKI and the maximum pRIFLE stage reached during PICU stay was noted. Detailed data regarding the treatment received and use of nephrotoxic drugs, inotropic support, mechanical ventilation, dialysis and total length of stay in PICU in all was noted. Outcome of the subjects were observed for survival or mortality.Results: Total 343 subjects were enrolled in the study. During the study 27.1% patients developed AKI according to pRIFLE staging. In AKI category 60.21% reached maximum risk category, 21.5% reached maximum injury category, 18.28% reached maximum failure category. Amongst AKI subjects 64.52% had infectious etiology. Multiorgan dysfunction, encephalopathy, shock, metabolic acidosis, hypertension, mechanical ventilation and nephrotoxic drugs administration were more associated with AKI and was statistically significant.Conclusions: Pediatric modification of RIFLE criteria is sensitive index to detect AKI at earliest in critically ill children for early intervention leading to better outcome.

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