scholarly journals P0571EPIDEMIOLOGY AND OUTCOMES OF ACUTE KIDNEY INJURY IN CHILDREN IN UKRAINE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Svitlana Fomina ◽  
Olga Lavrenchuk ◽  
Ingretta Bagdasarova

Abstract Background and Aims The problem of acute kidney injury (AKI) in children continues to be relevant for pediatric nephrology and pediatrics due to the increasing frequency and the lack of a unified approach to management and further monitoring of these patients. The aim of our study was to determine the etiology and outcomes of acute kidney damage in children. Method 101 patients (aged from 3 months) were studied in referral center from early period after AKI (first month) to 18 years old. They were observed every 6 months during first year of disease course, and once per year till transfer to adult clinic. The outcomes were identified as complete recovery, isolated albuminuria and chronic kidney disease (CKD). The AKI outcomes were analyzed up to 1.5-3, 5-10 and 15 years of follow up (stage 1, 2 and 3, respectively). Results The predominant patients were males (72/71.3%). The most of the children were younger than 3 years old at the time of AKI (58/57.4%), and only a small part of patients were adolescents (7/6.9%). The hemolytic uremic syndrome (HUS) related to diarrhea was the main cause of the AKI (64/63.4%), and children of the first years of life formed the basis of this clinical group (0-3 years old: 44/68.8%). Sepsis and complicated acute viral and bacterial infections have also been confirmed as common AKI causes (12/11.9% and 8/7.9%, respectively). In some cases AKI were associated with hemolytic anemia (5/5.0%), acute glomerulonephritis (5/5.0%), vaccination (1/1.0%), contrast nephrotoxicity (1/1.0%) or unknown cause (3/3.0%). At stage 1 (1.5-3 years after event, n=60) complete remission were documented in 24/40.0%, albuminuria from 45 to 601 mg/day without other clinical signs – in 22/36.7%, and CKD 2-4 – in 12/23.3%. At stage 2 (5-10 years after event, n=54) complete remission were confirmed in 29/53.7%, persisted albuminuria – in 6/14.8%, and CKD 2-4 – in 19/31.5%. At stage 3 (15 years after event, n=12) CKD 2-4 were founded in all patients with arterial hypertension (n=7), focal-segmental glomerulosclerosis (n=2) and kidney cysts (n=3). Conclusion AKI was the most often in children of the first 3 years old, mainly in boys. The development of disease was firstly associated with HUS and severe infections. The long-term outcomes of AKI with distance from the event (AKI) to CKD even with recovery renal function and absence of clinical symptoms were difficult to predict. The prolongation of the observation period, the collaboration between the pediatric and adult centers, the widest usage of verified prognostic markers (i. g. albuminuria) and search for new ones are the most important options in post-AKI management.

2014 ◽  
Vol 34 (5) ◽  
pp. 526-533 ◽  
Author(s):  
Mohamed Abdelraheem ◽  
El-Tigani Ali ◽  
Rania Osman ◽  
Rashid Ellidir ◽  
Amna Bushara ◽  
...  

BackgroundAcute Kidney Injury (AKI) is an important cause of morbidity and mortality in developing countries. Although continuous renal replacement therapy is gaining more popularity worldwide, peritoneal dialysis (PD) in children remains an appropriate therapy for AKI in children for all age groups including neonates.MethodologyWe retrospectively reviewed all children who have been admitted with AKI at the pediatric nephrology unit, Soba University Hospital, Khartoum, during the period from January 2005 to December 2011.ResultsOver 7 years we recorded 659 children of whom 362 (54.9%) were male. The spectrum of age was variable with the majority being neonates, 178 (27.1%). The average patient admission rate was 94 patients per year, with an estimated incidence of 9.8 patients/million population/year. Common causes of AKI were sepsis 202 (30.8%), acute glomerulonephritis 75 (11.5%) and obstructive uropathy due to stones 56 (8.5%). The most common dialysis modality used was PD, 343 (52.4%), and peritonitis was reported in 53 (15.4%) patients. Recovery from AKI was achieved in 450 (68.9%) children, 37 (5.7%) went into chronic kidney disease (CKD), 33 (5.1%) referred to the pediatric surgery and 194 (29.7%) died.ConclusionIn the setting of developing countries where AKI is a common cause of morbidity and mortality, reasonably equipped renal units with adequately trained medical staff may save many lives. International funding programs for communicable diseases and charity organizations should include AKI management in their programs. Acute PD remains the treatment modality of choice for AKI in developing countries.


Author(s):  
Ravindra Attur Prabhu ◽  
Tushar Shaw ◽  
Indu Ramachandra Rao ◽  
Vandana Kalwaje Eshwara ◽  
Shankar Prasad Nagaraju ◽  
...  

Abstract Background Melioidosis is a potentially fatal tropical infection caused by Burkholderia pseudomallei. Kidney involvement is possible, but has not been well described. Aim This study aimed to assess the risk of acute kidney injury (AKI) and its outcomes in melioidosis. Methods A retrospective observational cohort study was performed. Case records of consecutive patients with culture-confirmed melioidosis, observed from January 1st, 2012 through December 31st, 2019 were analysed for demographics, presence of comorbidities, including chronic kidney disease (CKD), diabetes mellitus (DM), and presence of bacteraemia, sepsis, shock, AKI, and urinary abnormalities. The outcomes we studied were: mortality, need for hospitalisation in an intensive care unit (ICU), duration of hospitalization. We then compared the outcomes between patients with and without AKI. Results Of 164 patients, AKI was observed in 59 (35.98%), and haemodialysis was required in eight (13.56%). In the univariate analysis, AKI was associated with CKD (OR 5.83; CI 1.140–29.90, P = 0.03), bacteraemia (OR 8.82; CI 3.67–21.22, P < 0.001) and shock (OR 3.75; CI 1.63–8.65, P = 0.04). In the multivariate analysis, CKD (adjusted OR 10.68; 95% CI 1.66–68.77; P = 0.013) and bacteraemia (adjusted OR 8.22; 95% CI 3.15–21.47, P < 0.001) predicted AKI. AKI was associated with a greater need for ICU care (37.3% vs. 13.3%, P = 0.001), and mortality (32.2% vs. 5.7%, P < 0.001). Mortality increased with increasing AKI stage, i.e. stage 1 (OR 3.52, CI 0.9–13.7, P = 0.07), stage 2 (OR 6.79, CI 1.92–24, P = 0.002) and stage 3 (OR 17.8, CI 5.05–62.8, P < 0.001), however kidney function recovered in survivors. Hyponatremia was observed in 138 patients (84.15%) and isolated urinary abnormalities were seen in 31(18.9%). Conclusions AKI is frequent in melioidosis and occurred in 35.9% of our cases. Hyponatremia is likewise common. AKI was predicted by bacteraemia and CKD, and was associated with higher mortality and need for ICU care; however kidney function recovery was observed in survivors. Graphic abstract


2016 ◽  
Vol 17 (7) ◽  
pp. 615-623 ◽  
Author(s):  
Joshua H. Wong ◽  
David T. Selewski ◽  
Sunkyung Yu ◽  
Kay E. Leopold ◽  
Katelyn H. Roberts ◽  
...  

Author(s):  
Pierluigi Marzuillo ◽  
Maria Baldascino ◽  
Stefano Guarino ◽  
Silverio Perrotta ◽  
Emanuele Miraglia del Giudice ◽  
...  

Abstract Background We aimed to evaluate prevalence of acute kidney injury (AKI) and its risk factors in children hospitalized for acute gastroenteritis (AGE) to identify early predictors of AKI. Methods We retrospectively collected clinical and biochemical data of 114 children (57.9% male; mean age 2.9 ± 2.8 years) hospitalized for AGE. AKI was defined according to Kidney Disease/Improving Global Outcomes creatinine criteria. We considered basal serum creatinine as value of creatinine estimated with Hoste (age) equation assuming basal eGFRs were median age-based eGFR normative values for children ≤ 2 years of age, and eGFR 120 mL/min/1.73m2 for children > 2 years. Univariate and multivariate logistic regression models were used to explore associations with AKI. We included in multivariate analyses only variables with significant p after Bonferroni correction. Results AKI was found in 28/114 (24.6%) patients. No patients required hemodialysis, 2 (1.8%) reached AKI stage 3, 2 (1.8%) AKI stage 2, and 24 (21.0%) AKI stage 1. Mean length of stay was 3.6 ± 1.2, 5.0 ± 1.8, and 10.5 ± 5.8 days, for patients with no, mild, and severe AKI (p < 0.001), respectively. Duration of symptoms before hospitalization (OR = 2.5; 95% CI = 1.3–5.0; p = 0.006), dehydration > 5% (OR = 43.1; 95% CI = 5.4–344.1; p = < 0.001), and serum bicarbonate levels (OR = 1.6; 95% CI = 1.2–2.1; p = 0.001) were independent predictors of AKI. Conclusions About one quarter of patients hospitalized for AGE may suffer from AKI with a longer stay for patients with more severe AKI. Particular attention, however, should be paid to volemia and kidney health of patients with AGE especially in the presence of increased duration of symptoms before hospitalization, dehydration, and lower serum bicarbonate levels. Graphical abstract


Author(s):  
Michelle Ramírez ◽  
Sujata Chakravarti ◽  
Jaclyn McKinstry ◽  
Yasir Al-qaqaa ◽  
Raj Sahulee ◽  
...  

Abstract Objectives: This article investigated the utility of urine biomarkers tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) in identifying acute kidney injury (AKI) in neonates after congenital heart surgery (CHS). TIMP-2 and IGFBP-7 are cell cycle arrest proteins detected in urine during periods of kidney stress/injury. Methods: We conducted a single-center, prospective study between September 2017 and May 2019 with neonates undergoing CHS requiring cardiopulmonary bypass (CPB). Urine samples were analyzed using NephroCheck prior to surgery and 6, 12, 24, and 96 hours post-CPB. All patients were evaluated using the Acute Kidney Injury Network (AKIN) criteria. Wilcoxon rank sum tests were used to compare the medians of the [TIMP-2*IGFBP-7] values in the AKIN negative and positive groups at each time point. Receiver operating characteristic curves were used to measure how well the [TIMP-2*IGFBP-7] values predict AKIN status. Results: Thirty-six patients were included. No patients met the AKIN criteria for AKI preoperatively. Postoperatively, 19 patients (53%) met the AKIN criteria for AKI diagnosis: 13 (36%) stage 1, 5 (14%) stage 2, and 1 (3%) stage 3. None required renal replacement therapy. At the 24-hour time points, patients who met the AKIN criteria for AKI had a statistically significantly higher [TIMP-2*IGFBP7] values than the patients without AKI (1.1 vs. 0.27 [ng/mL]2/1,000) at 24 hours (adj-p = 0.0019). Conclusion: AKI is a serious complication associated with adverse outcomes in patients undergoing cardiac surgery. [TIMP-2*IGFBP-7] urinary level 24 hours after CPB is a good predictor of AKI in this population.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Imen El Meknassi ◽  
Mrabet Sanda ◽  
Guedri Yosra ◽  
Zellema Dorsaf ◽  
Azzabi Awatef ◽  
...  

Abstract Background and Aims Acute post-infectious glomerulonephritis (APIGN) is a reactive immunological disease. Its prevalence in industrialized countries is declining contrasting with developed ones. It is uncommon in adults but the prognosis may be reserved. The aim of our study was to evaluate the epidemiological, clinical and histological features of APIGN as well as its prognosis. Method A retrospective and descriptive study was conducted in our department. Were included all cases of histologically proven APIGN between December 2006 and December 2017. Results We had collected 38 cases. The mean age was 37.7 ± 17.8 years. The sex ratio was 1.92. Twelve (31.6%) patients were diabetic and four of them had already a chronic kidney disease (CKD). APIGN was preceded by an infection in 27 cases with an average interval of 10 ± 5 days. The most common site of infection was the respiratory tract (15 cases). At presentation, 27 patients had nephritic syndrome and 13 had nephrotic-range proteinuria. Hematuria was observed in 97.4%, peripheral edema in 84.2% and hypertension in 73.7% of cases. Most patients (78.9%) had acute kidney injury and 10 (26.3%) patients required dialysis. Renal biopsy had shown benign acute glomerulonephritis in 31 cases and malignant form in 7 cases. An underlying nephropathy was found in 12 cases with mostly a diabetic nephropathy. Corticosteroids were used in 3 cases of benign APIGN and 5 cases of malignant form. During the follow-up, CKD was noted in 14(36.8%) patients including 7(18.4%) patients who progressed to end-stage renal disease. Poor prognostic factors were diabetes, the presence of an underlying nephropathy in the biopsy, acute kidney injury and the need for dialysis. Conclusion The APIGN is uncommon in adults, yet its prognosis may be reserved with progression to CKD.


2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Andrea L. Conroy ◽  
Michael Hawkes ◽  
Robyn E. Elphinstone ◽  
Catherine Morgan ◽  
Laura Hermann ◽  
...  

Abstract Background.  Acute kidney injury (AKI) is a well recognized complication of severe malaria in adults, but the incidence and clinical importance of AKI in pediatric severe malaria (SM) is not well documented. Methods.  One hundred eighty children aged 1 to 10 years with SM were enrolled between 2011 and 2013 in Uganda. Kidney function was monitored daily for 4 days using serum creatinine (Cr). Acute kidney injury was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Blood urea nitrogen (BUN) and Cr were assessed using i-STAT, and cystatin C (CysC) was measured by enzyme-linked immunosorbent assay. Results.  Eighty-one (45.5%) children had KDIGO-defined AKI in the study: 42 (51.9%) stage 1, 18 (22.2%) stage 2, and 21 (25.9%) stage 3. Acute kidney injury evolved or developed in 50% of children after admission of hospital. There was an increased risk of AKI in children randomized to inhaled nitric oxide (iNO), with 47 (54.0%) of children in the iNO arm developing AKI compared with 34 (37.4%) in the placebo arm (relative risk, 1.36; 95% confidence interval [CI], 1.03–1.80). Duration of hospitalization increased across stages of AKI (P = .002). Acute kidney injury was associated with neurodisability at discharge in the children receiving placebo (25% in children with AKI vs 1.9% in children with no AKI, P = .002). Mortality increased across stages of AKI (P = .006) in the placebo arm, reaching 37.5% in stage 3 AKI. Acute kidney injury was not associated with neurodisability or mortality at discharge in children receiving iNO (P &gt; .05 for both). Levels of kidney biomarkers were predictive of mortality with areas under the curves (AUCs) of 0.80 (95% CI, .65–.95; P = .006) and 0.72 (95% CI, .57–.87; P &lt; .001), respectively. Admission levels of CysC and BUN were elevated in children who died by 6 months (P &lt; .0001 and P = .009, respectively). Conclusions.  Acute kidney injury is an underrecognized complication in young children with SM and is associated with increased mortality.


2020 ◽  
Vol 4 (2) ◽  
pp. 21-28
Author(s):  
Jonathan S Chávez-Iñiguez ◽  
Jose Said Cabrera-Aguilar ◽  
Guillermo Garcia-Garcia ◽  
Juan Armendáriz-Borunda

Leptospirosis is considered a zoonosis acquired predominantly from contaminated surfaces and water, more commonly in emerging countries with limited sanitary conditions. Leptospira in the host unleashes an immune response that explains the symptoms and clinical signs; once it reaches the kidney and liver tissue, it can manifest with alterations that lead to acute and chronic diseases in both organs. Weil’s syndrome is the best known clinical manifestation with jaundice and acute kidney injury that could lead to multiple organ failure and death. For its diagnosis, there are simplified scores such as the SPiRO score, the microbiological criteria by microscopy or serological tests; the treatment focuses on antibiotics and, if necessary, provides organic support until the infection is curtailed. The purpose of this review was to address the impact of Lep-tospira infection on the kidney and liver, the mechanisms of organ damage, the clinical presentation, and diagnosis and management of this disease.


2022 ◽  
Vol 7 (1) ◽  
pp. 11-17
Author(s):  
Rahmat Ali Khan ◽  
Syed Munib ◽  
Mohammad Shahzad ◽  
Mufti Baleegh ◽  
Liaqat Ali ◽  
...  

  Background: Acute kidney injury may increase the risk for CKD and end-stage renal disease. In an attempt to summarize the literature and provide more compelling evidence, we conducted a systematic review comparing the  risk for CKD (chronic kidney disease), AKI (Acute kidney injury), Acute gastroententeritis, postnatal   AKI, Acute MI (myocardial infarction), AKI  2ndry to chemotherapy, AKI  2ndry to abstractive Nephropathy, AKI 2ndry to sepsis, AKI 2ndry to Drugs (NSAIDS and ARBS), AKI 2ndry to AGN (acute Glomerulonephritis), AKI 2ndry to Rhabdomyolysis, and lest AKI 2ndry to Malaria, death in patients with AKI,HD, CKD (chronic kidney disease). There have been several important developments in the literature recently regarding the association between acute kidney injury (AKI) and chronic kidney disease (CKD). First, when the National Kidney Foundation promulgated their highly influential Kidney Disease Outcomes Quality Initiative CKD guidelines in 2002, six chapters were devoted to the complications associated with decreased glomerular filtration rate (GFR) including hypertension, anemia, nutritional status, bone disease/disorders of calcium, and phosphorus metabolism, neuropathy Objective: To study the outcomecute kidney injury following chronic kidney disease; systematic review.  Methods: This was a prospective observational study from January 2018 to December 2020. Patients visiting department of Nephrology Nawaz Sharif Kidney center Swat, number of patients included study 351. All ages and both sexes were considered. Patients treated elsewhere or who has undergone in this study. Complete medical history, detailed examination like age, sex, diagnosis, and outcome, of AKI, examination under microscope and investigations, and necessary blood investigations were carried out. Results: Three fifty one (351) patients were included in this study. The age distribution showed (75%) patients between 40-95 years and 25(25%) between 32-39 years. Mean age was 43 years with Standard Deviation of ± 35.66. Among 351 patients 162 (45%) patients were male and 189 (55%) patients were female. Duration of symptoms in 24(17%) was <4 months and 112(75%) had >4 months, with mean of 4 months and SD ± 2.315. Total 351 participants AKI 45(12%) postnatal AKI 33(9%) Acute MI 18(6%) AKI 2ndry chemotherapy 15(5.72%) AKI 2ndry to abstractive Nephropathy 55 (14%) AKI 2ndry to sepsis 63 (17%) AKI 2ndry to Drugs (NSAIDS and ARBS)   54 (14%) CKD (chronic kidney disease) 48 (15%) AKI 2ndry to Rhabdomylysis 18(6%) Conclusions: The study concludes that the acute kidney injury following CKD systematic reviewing among patients presenting with AKI,CHD ,AKI sepsis, ,AKI Drugs(NSIAD)  in local hospital  settings This can be reduced with proper health education in general public regarding prevention of the disease and hence its complications.  


Author(s):  
Chandrashekar Udyavara Kudru ◽  
Vandana Kalwaje Eshwara ◽  
Shivashankara Kaniyoor Nagiri ◽  
Vasudeva Guddattu

Introduction. Bacterial infections are more frequent in patients with decompensated cirrhosis than those with compensated liver disease and account for significant morbidity and mortality in them. Once an infection develops, it induces excessive production of pro-inflammatory cytokines leading to organ failure and death. Aims. This study aims to identify the clinical characteristics and outcome of bacterial infections affecting various organ systems in patients with liver cirrhosis and to determine factors associated with mortality. Materials and methods. A cross sectional study was performed on subjects with cirrhosis having microbiologically proven bacterial infection involving various organ systems, admitted to a tertiary care hospital in southern India. Demographic, clinical data, laboratory parameters and outcome details were noted. Univariate associations and subsequent multivariate logistic regression analysis was performed to determine factors associated with mortality. Results. The study included 158 patients. Chronic alcohol intake was the most common etiology of cirrhosis (66.4%). Community acquired infections occurred more frequently than hospital acquired infections (85.5% vs 14.5%). The common site of isolation of etiological agent was ascitic fluid (38.3%) followed by blood (24.3%), respiratory tract (15.5%) and urinary tract (14.5%). Gram negative bacterial infections were more common (74.3%), Escherichia coli being the most frequent pathogen (38.5%). Mortality was noted in 38 (24%) patients. The factors associated with mortality were the type of infection, Child Pugh category, acute kidney injury, hepatic encephalopathy, urinary tract infection, and creatinine and bilirubin levels. Multivariate logistic regression analysis revealed that type of infection (OR: 0.33, 95% CI: 0.11-1.01), ascitic fluid infection (OR: 2.81, 95% CI: 1.11-7.12), hepatic encephalopathy (OR: 0.17, 95% CI: 0.070-0.422) and acute kidney injury (OR: 0.19, 95% CI: 0.077-0.502) were significantly associated with in-hospital mortality. Conclusion. This study indicates that the type of infection, hepatic encephalopathy, ascitic fluid infection and acute kidney injury are associated with mortality in cirrhotic patients. Early effective treatment and prevention of these complications may help modify the outcome.


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