Department of Pediatrics, Pediatric Nephrology and Rheumatology Unit, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, 06100, Turkey.
Pediatr Nephrol. 2010 Aug;25(8):1453-61. doi: 10.1007/s00467-010-1541-y. Epub 2010 May 30.
The aim of this prospective, multicenter study was to define the etiology and clinical features of acute kidney injury (AKI) in a pediatric patient cohort and to determine prognostic factors. Pediatric-modified RIFLE (pRIFLE) criteria were used to classify AKI. The patient cohort comprised 472 pediatric patients (264 males, 208 females), of whom 32.6% were newborns (median age 3 days, range 1-24 days), and 67.4% were children aged >1 month (median 2.99 years, range 1 month-18 years). The most common medical conditions were prematurity (42.2%) and congenital heart disease (CHD, 11.7%) in newborns, and malignancy (12.9%) and CHD (12.3%) in children aged >1 month. Hypoxic/ischemic injury and sepsis were the leading causes of AKI in both age groups. Dialysis was performed in 30.3% of newborns and 33.6% of children aged >1 month. Mortality was higher in the newborns (42.6 vs. 27.9%; p < 0.005). Stepwise multiple regression analysis revealed the major independent risk factors to be mechanical ventilation [relative risk (RR) 17.31, 95% confidence interval (95% CI) 4.88-61.42], hypervolemia (RR 12.90, 95% CI 1.97-84.37), CHD (RR 9.85, 95% CI 2.08-46.60), and metabolic acidosis (RR 7.64, 95% CI 2.90-20.15) in newborns and mechanical ventilation (RR 8.73, 95% CI 3.95-19.29), hypoxia (RR 5.35, 95% CI 2.26-12.67), and intrinsic AKI (RR 4.91, 95% CI 2.04-11.78) in children aged >1 month.
本前瞻性、多中心研究旨在明确儿科患者急性肾损伤（AKI）的病因和临床特征，并确定预后因素。采用儿科改良的 RIFLE（pRIFLE）标准对 AKI 进行分类。该患者队列包括 472 名儿科患者（男 264 例，女 208 例），其中 32.6%为新生儿（中位年龄 3 天，范围 1-24 天），67.4%为 1 个月以上的儿童（中位年龄 2.99 岁，范围 1 个月-18 岁）。最常见的医疗条件是早产（42.2%）和先天性心脏病（CHD，11.7%）在新生儿中，以及恶性肿瘤（12.9%）和 CHD（12.3%）在 1 个月以上的儿童中。缺氧/缺血损伤和败血症是两组患儿 AKI 的主要原因。在新生儿中，有 30.3%需要进行透析，而在 1 个月以上的儿童中，有 33.6%需要进行透析。新生儿死亡率较高（42.6%比 27.9%；p<0.005）。逐步多元回归分析显示，主要的独立危险因素是机械通气[相对风险（RR）17.31，95%置信区间（95%CI）4.88-61.42]、血容量过多（RR 12.90，95%CI 1.97-84.37）、CHD（RR 9.85，95%CI 2.08-46.60）和代谢性酸中毒（RR 7.64，95%CI 2.90-20.15）在新生儿中，机械通气（RR 8.73，95%CI 3.95-19.29）、缺氧（RR 5.35，95%CI 2.26-12.67）和固有 AKI（RR 4.91，95%CI 2.04-11.78）在 1 个月以上的儿童中。
