P0571EPIDEMIOLOGY AND OUTCOMES OF ACUTE KIDNEY INJURY IN CHILDREN IN UKRAINE
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.