Bajracharya Punam, Kalra Suprita, Dhingra Sandeep, Sood Amit, Yadav A K, Kanitkar Madhuri
Resident, Department of Pediatrics, Armed Forces Medical College, Pune 411040, India.
Associate Professor (Pediatrics & Pediatric Nephrology), Department of Pediatrics, Armed Forces Medical College, Pune 411040, India.
Med J Armed Forces India. 2020 Jan;76(1):84-88. doi: 10.1016/j.mjafi.2019.02.003. Epub 2019 May 29.
Acute kidney injury (AKI) is shown to be the commonest complication in critically ill children admitted to the pediatric intensive care unit (PICU). Kidney Disease: Improving Global Outcomes (KDIGO) classification and definition are now used universally. We undertook prospective observational study to study the etiology and maximum stage of AKI as defined by KDIGO and its complications and outcomes.
All children admitted to the PICU were included in the study. The diagnosis of sepsis and multiorgan dysfunction syndrome (MODS) was made according to the standard international guidelines. The patients were followed up till discharge/death. All children were screened for AKI at admission and subsequently using serum creatinine measured by modified Jaffe's method and urine output measurement.
A total of 197 children were admitted to the PICU. 38 (19.28%) developed AKI, and 6 (15.78%) developed stage III AKI. Malignancies, serious neurological and renal disorders, and postsurgery complications accounted for most of the cases with AKI. Six were admitted with primary renal condition. Sepsis with or without MODS was seen in 12 patients with AKI and in 8 without AKI. Twenty-one children with AKI and 3 children without AKI were exposed to nephrotoxic drugs. Twenty-three children with AKI required inotropic support. The average length of stay (ALOS) of children with AKI in the PICU was 9.86 days, whereas ALOS of children without AKI was 6.23 days. Eighteen children with AKI (47.36%) and 36 (21.38%) with no AKI died.
AKI in children in the PICUs of referral hospitals in the armed forces have varied etiologies and presentations. These children require early identification and management with close monitoring to prevent long-term renal morbidity and mortality.
急性肾损伤（AKI）是儿科重症监护病房（PICU）收治的危重症儿童中最常见的并发症。目前，肾脏病改善全球预后（KDIGO）分类和定义已被广泛应用。我们进行了前瞻性观察研究，以探讨KDIGO定义的AKI的病因、最高分期及其并发症和预后。
纳入所有入住PICU的儿童。根据国际标准指南诊断脓毒症和多器官功能障碍综合征（MODS）。对患者进行随访直至出院/死亡。所有儿童在入院时及随后均通过改良Jaffe法测定血清肌酐和测量尿量来筛查AKI。
共有197名儿童入住PICU。38例（19.28%）发生AKI，6例（15.78%）发展为Ⅲ期AKI。恶性肿瘤、严重神经和肾脏疾病以及术后并发症占AKI病例的大多数。6例因原发性肾脏疾病入院。12例AKI患者和8例非AKI患者出现脓毒症伴或不伴MODS。21例AKI儿童和3例非AKI儿童接触过肾毒性药物。23例AKI儿童需要使用血管活性药物支持。AKI儿童在PICU的平均住院时间（ALOS）为9.86天，而非AKI儿童的ALOS为6.23天。18例AKI儿童（47.36%）和36例非AKI儿童（21.38%）死亡。
军队转诊医院PICU中的儿童AKI病因和表现各异。这些儿童需要早期识别和管理，并密切监测，以预防长期肾脏疾病及死亡。
