Balestracci Alejandro, Ezquer Mauricio, Elmo María Eugenia, Molini Andrea, Thorel Claudia, Torrents Milagros, Toledo Ismael
Nephrology Unit, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, 1270, Ciudad Autónoma de Buenos Aires, Argentina,
Pediatr Nephrol. 2015 Oct;30(10):1873-8. doi: 10.1007/s00467-015-3105-7. Epub 2015 Apr 21.
Non-steroidal anti-inflammatory drugs (NSAIDs) induce acute kidney injury (AKI) in volume-depleted patients; however the prevalence of this complication is likely underestimated. We assessed the impact of ibuprofen exposure on renal function among dehydrated children with acute gastroenteritis (AGE) to further characterize NSAID-associated AKI.
Over a 1-year period dehydrated children with AGE (n = 105) were prospectively enrolled and grouped as cases, presenting with AKI (n = 46) or controls, not presenting with AKI (n = 59). AKI was defined by pediatric RIFLE (pRIFLE) criteria.
Among the children enrolled in the study, AKI prevalence was 44 %, and 34 (54 %) of the 63 patients who received ibuprofen developed renal impairment. Relative to the controls, children presenting with AKI were younger (median age 0.66 vs. 1.74 years; p < 0.001) and received ibuprofen more frequently (74 vs. 49 %, p = 0.01). After adjusting for the degree of dehydration, ibuprofen exposure remained an independent risk factor for AKI (p < 0.001, odds ratio 2.47, 95 % confidence interval 1.78-3.42). According to the pRIFLE criteria, 17 patients were at the 'risk' stage of AKI severity, 24 were at the 'injury' stage, and five were at the 'failure' stage; none required dialysis. Distribution of patients within categories was similar regardless of ibuprofen exposure. All cases fulled recovered from AKI.
Ibuprofen-associated AKI was 54 % in our cohort of dehydrated children with AGE. Drug exposure increased the risk for developing AKI by more than twofold, independent of the magnitude of the dehydration.
非甾体类抗炎药（NSAIDs）可导致容量不足患者发生急性肾损伤（AKI）；然而，这种并发症的发生率可能被低估了。我们评估了布洛芬暴露对急性胃肠炎（AGE）脱水儿童肾功能的影响，以进一步明确NSAIDs相关AKI的特征。
在1年的时间里，前瞻性纳入AGE脱水儿童（n = 105），分为病例组（出现AKI，n = 46）和对照组（未出现AKI，n = 59）。AKI根据儿科RIFLE（pRIFLE）标准定义。
在纳入研究的儿童中，AKI发生率为44%，63例接受布洛芬治疗的患者中有34例（54%）出现肾功能损害。与对照组相比，出现AKI的儿童更年幼（中位年龄0.66岁对1.74岁；p < 0.001），且更频繁地接受布洛芬治疗（74%对49%，p = 0.01）。在调整脱水程度后，布洛芬暴露仍然是AKI的独立危险因素（p < 0.001，比值比2.47，95%置信区间1.78 - 3.42）。根据pRIFLE标准，17例患者处于AKI严重程度的“风险”阶段，24例处于“损伤”阶段，5例处于“衰竭”阶段；无人需要透析。无论是否暴露于布洛芬，患者在各分类中的分布相似。所有病例均从AKI中完全康复。
在我们的AGE脱水儿童队列中，布洛芬相关AKI发生率为54%。药物暴露使发生AKI的风险增加两倍多，与脱水程度无关。
