Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Division of Hospital Medicine, Division of Biomedical Informatics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
J Pediatr. 2014 Sep;165(3):522-7.e2. doi: 10.1016/j.jpeds.2014.04.058. Epub 2014 Jun 11.
To assess the development of chronic kidney disease (CKD) after high nephrotoxic medication exposure-associated acute kidney injury (NTMx-AKI) in hospitalized children.
We performed a retrospective cohort study of children exposed to an aminoglycoside for ≥3 days or ≥3 nephrotoxic medications simultaneously for the development of CKD at 6 months. Follow-up data >6 months after acute kidney injury (AKI) were retrieved from electronic health records. Outcomes in children with NTMx-AKI were compared with patients of same age and primary service distribution who were exposed to nephrotoxic medications but did not develop AKI (controls).
One hundred patients with NTMx-AKI were assessed (mean age of 9.3 ± 6.9 years). Commonly involved services were bone marrow transplantation/oncology (59%), liver transplantation (13%), and pulmonary (13%). Pre-AKI estimated glomerular filtration rate (eGFR) was 119 ± 14.5 mL/min/1.73 m(2) (range 90-150 mL/min/1.73 m(2)). Mean discharge eGFR was 105.1 ± 27.1 mL/min/1.73 m(2). At 6 months after NTMx-AKI, eGFR (n = 77) was 113.8 ± 30.6 mL/min/1.73 m(2). Sixteen (20.7%) had eGFR of 60-90, 2 (2.6%) had eGFR <60, and 9 (11.6%) had eGFR >150 mL/min/1.73 m(2) (hyperfiltration). Twenty-four (68.5%) of 35 patients who were assessed for proteinuria had a urine protein-to-creatinine ratio >0.3 mg/mg, and 29 (37.6%) had hypertension. Twenty-six (33.7%) patients had CKD (proteinuria or eGFR <60 mL/min/1.73 m(2)). An additional 28 (36.3%) were considered to be at risk for CKD with hypertension, eGFR between 60 and 90 mL/min/1.73 m(2), or eGFR >150 mL/min/1.73 m(2). CKD, hypertension, and proteinuria were more common in the AKI cohort than in controls.
Six months after NTMx-AKI, 70% of patients had evidence of residual kidney damage (reduced eGFR, hyperfiltration, proteinuria, or hypertension). Few underwent a complete evaluation for CKD. With studies showing an association between AKI and CKD, we suggest systematic comprehensive follow-up in children after NTMx-AKI.
评估高肾毒性药物暴露相关急性肾损伤（NTMx-AKI）后住院儿童慢性肾脏病（CKD）的发展情况。
我们对接受氨基糖苷类药物治疗≥3 天或同时接受≥3 种肾毒性药物治疗的儿童进行了一项回顾性队列研究，以评估其在 6 个月时发生 CKD 的情况。从电子病历中检索急性肾损伤（AKI）后随访数据>6 个月。将 NTMx-AKI 患儿的结果与接受肾毒性药物但未发生 AKI（对照组）的同年龄和主要服务分布的患者进行比较。
共评估了 100 例 NTMx-AKI 患儿（平均年龄 9.3±6.9 岁）。常见的涉及科室为骨髓移植/肿瘤学（59%）、肝移植（13%）和肺部（13%）。AKI 前估算肾小球滤过率（eGFR）为 119±14.5mL/min/1.73m²（范围 90-150mL/min/1.73m²）。出院时 eGFR 为 105.1±27.1mL/min/1.73m²。在 NTMx-AKI 后 6 个月时，对 77 例患者进行了 eGFR 评估，结果为 113.8±30.6mL/min/1.73m²。16 例（20.7%）eGFR 为 60-90，2 例（2.6%）eGFR <60，9 例（11.6%）eGFR >150mL/min/1.73m²（高滤过）。35 例接受蛋白尿评估的患者中，24 例（68.5%）尿蛋白/肌酐比值>0.3mg/mg，29 例（37.6%）患有高血压。26 例（33.7%）患者患有 CKD（蛋白尿或 eGFR <60mL/min/1.73m²）。另有 28 例（36.3%）患者因高血压、eGFR 为 60-90mL/min/1.73m²或 eGFR >150mL/min/1.73m²，被认为存在 CKD 风险。与对照组相比，AKI 组的 CKD、高血压和蛋白尿更为常见。
在 NTMx-AKI 后 6 个月，70%的患者存在肾脏损伤的残留证据（eGFR 降低、高滤过、蛋白尿或高血压）。很少有患者接受了 CKD 的全面评估。由于研究表明 AKI 与 CKD 之间存在关联，我们建议对 NTMx-AKI 后儿童进行系统的全面随访。
