Estimating baseline creatinine values to define acute kidney injury in critically ill pediatric patients

Acute kidney injury (AKI) is a clinical syndrome that manifests as an abrupt impairment of kidney function. AKI is common in critically ill pediatric patients admitted to the pediatric intensive care units. AKI is a deleterious complication in critically ill children as it is associated with increased morbidity and mortality. This review provides an overview of the incidence, morbidity, and mortality of AKI in critically ill children in general and specific cohorts such as post-cardiac surgeries, sepsis, critically ill neonates, and post stem cell transplantation.

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Acetazolamide-Associated Acute Kidney Injury in Critically Ill Pediatric Patients

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-26.5.467 ◽

2021 ◽

Vol 26 (5) ◽

pp. 467-471

Author(s):

Brady S. Moffett ◽

Kelli Kulik ◽

Mahmood Khichi ◽

Ayse Arikan

Keyword(s):

Acute Kidney Injury ◽

Logistic Regression ◽

Critically Ill ◽

Pediatric Patients ◽

Kidney Injury ◽

Ordinal Logistic Regression ◽

Patient Demographics ◽

Included Patient ◽

Ordinal Logistic Regression Analysis ◽

Ordinal Logistic Regression Model

OBJECTIVE Our objective was to determine the incidence and risk factors for intravenous acetazolamide-associated acute kidney injury (AKI). METHODS We utilized a retrospective cohort study including patients <19 years of age initiated on intravenous acetazolamide while admitted to an ICU. Data collection included patient demographics, clinical variables, acetazolamide dosing, and serum creatinine (SCr) values. Incidence of AKI was assessed per Kidney Disease Improving Global Outcomes criteria. Descriptive statistical analysis and ordinal logistic regression analysis were performed to determine the incidence of AKI and variables associated with AKI. RESULTS A total of 868 patients met study criteria (male 55.8%, median age 0.66 years [IQR 0.19, 3.0 years]). Intravenous acetazolamide was administered at 5.1 ± 2.8 mg/kg/dose for a median of 4 doses (IQR 2, 6). Median baseline SCr was 0.28 mg/dL (IQR 0.22, 0.37), corresponding to a creatinine clearance of 115 ± 55 mL/min/1.73 m2. Acute kidney injury occurred in 26.8% (n = 233) of patients (stage I = 20.1%, stage II = 3.7%, stage III 3.1%), and no patients received renal replacement therapy. An ordinal logistic regression model identified an increased odds of AKI with cyclosporine, ethacrynic acid, and piperacillin-tazobactam administration. CONCLUSIONS Acute kidney injury occurs frequently in critically ill pediatric patients receiving intravenous acetazolamide.

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Urinary NMR Profiling in Pediatric Acute Kidney Injury—A Pilot Study

International Journal of Molecular Sciences ◽

10.3390/ijms21041187 ◽

2020 ◽

Vol 21 (4) ◽

pp. 1187 ◽

Cited By ~ 1

Author(s):

Muhle-Goll ◽

Eisenmann ◽

Luy ◽

Kölker ◽

Tönshoff ◽

...

Keyword(s):

Acute Kidney Injury ◽

Nmr Spectroscopy ◽

Diagnostic Accuracy ◽

Critically Ill ◽

Pediatric Patients ◽

Kidney Injury ◽

Critically Ill Children ◽

Healthy Children ◽

Operating Characteristics ◽

Urinary Citrate

Acute kidney injury (AKI) in critically ill children and adults is associated with significant short- and long-term morbidity and mortality. As serum creatinine- and urine output-based definitions of AKI have relevant limitations, there is a persistent need for better diagnostics of AKI. Nuclear magnetic resonance (NMR) spectroscopy allows for analysis of metabolic profiles without extensive sample manipulations. In the study reported here, we examined the diagnostic accuracy of NMR urine metabolite patterns for the diagnosis of neonatal and pediatric AKI according to the Kidney Disease: Improving Global Outcomes (KDIGO) definition. A cohort of 65 neonatal and pediatric patients (0–18 years) with established AKI of heterogeneous etiology was compared to both a group of apparently healthy children (n = 53) and a group of critically ill children without AKI (n = 31). Multivariate analysis identified a panel of four metabolites that allowed diagnosis of AKI with an area under the receiver operating characteristics curve (AUC-ROC) of 0.95 (95% confidence interval 0.86–1.00). Especially urinary citrate levels were significantly reduced whereas leucine and valine levels were elevated. Metabolomic differentiation of AKI causes appeared promising but these results need to be validated in larger studies. In conclusion, this study shows that NMR spectroscopy yields high diagnostic accuracy for AKI in pediatric patients.

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