Olowu Wasiu Adekunle, Adefehinti Olufemi, Bisiriyu Adeleke Lukman
Pediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.
Saudi J Kidney Dis Transpl. 2012 Jan;23(1):68-77.
This study determined the (1) hospital incidence, prevalence and etiology; (2) frequency of each of the acute kidney injury (AKI) stages and (3) the 60-day outcome. Retrospective analysis of clinico-laboratory data of Nigerian children/adolescents with hospital-acquired acute kidney injury (hAKI) was performed. AKI occurred in 103 (3.13%) of 3,286 childhood and adolescent admissions. Twenty-eight (27.2%) were hAKI while 72.8% were community-acquired AKI (cAKI). Annual hAKI incidence and prevalence rates were 0.17% (or 3.7 per million children population [pmcp]/year) and 0.84% (or 18.3 pmcp), respectively. Male (20):female (8) ratio was 2.5:1. In the hAKI group, median age was 5 (0.063-15.0) years. AKI stages 1, 2 and 3 accounted for 14.3%, 25.0% and 60.7%, respectively. AKI stage 3 was most anuric, with high dialysis requirement (P = 0.0329). Nephrotoxics (42.87%) were a leading cause of hAKI. Seventy-five percent of the recorded deaths were in the first 28 hAKI days. Median survival time was 23.5 admission (11-52) days. The means values of maximum serum creatinine (Scr) for survivors (486.0 ± 382.0 μmol/L or 5.5 ± 4.3 mg/dL) and for non-survivors (353.0 ± 160.0 μmol/L or 4.0 ± 1.8 mg/dL) were similar (P > 0.20). The 60-day cumulative mortality was 36.7%. Scr severity may not be a reliable mortality determinant among AKI patients. The maximal mortality in the first 28 days of hAKI onset and overall high mortality rate indicate that high level of clinical vigilance and informed therapeutic intervention will be critical to survival during this period. Cause of death was multi-factorial.
（1）医院发病率、患病率及病因；（2）各急性肾损伤（AKI）分期的频率；以及（3）60天的预后情况。对尼日利亚患有医院获得性急性肾损伤（hAKI）的儿童/青少年的临床实验室数据进行了回顾性分析。在3286例儿童和青少年住院病例中，有103例（3.13%）发生了AKI。其中28例（27.2%）为hAKI，72.8%为社区获得性AKI（cAKI）。hAKI的年发病率和患病率分别为0.17%（或每百万儿童人口每年3.7例[pmcp/年]）和0.84%（或18.3 pmcp）。男女比例为2.5:1（男20例：女8例）。在hAKI组中，中位年龄为5（0.063 - 15.0）岁。AKI 1期、2期和3期分别占14.3%、25.0%和60.7%。AKI 3期无尿情况最为严重，透析需求高（P = 0.0329）。肾毒性物质（42.87%）是hAKI的主要原因。记录的死亡病例中有75%发生在hAKI的前28天内。中位生存时间为入院后23.5天（11 - 52天）。幸存者的最大血清肌酐（Scr）均值（486.0 ± 382.0 μmol/L或5.5 ± 4.3 mg/dL）与非幸存者（353.0 ± 160.0 μmol/L或4.0 ± 1.8 mg/dL）相似（P > 0.20）。60天累积死亡率为36.7%。在AKI患者中，Scr严重程度可能不是可靠的死亡决定因素。hAKI发病后前28天的最高死亡率及总体较高的死亡率表明，在此期间保持高度临床警惕和进行明智的治疗干预对生存至关重要。死亡原因是多因素的。
