Department of Pediatrics, Chonnam National University Hospital and Medical School, Gwangju, South Korea.
Department of Pediatrics, Jeil Hospital, Yeosu, South Korea.
Indian J Pediatr. 2021 Jun;88(6):568-573. doi: 10.1007/s12098-020-03549-9. Epub 2020 Nov 19.
To assess the incidence and clinical characteristics of acute kidney injury (AKI) and identify the associated risk factors for AKI in children with type 1 diabetes mellitus (T1DM) and diabetic ketoacidosis (DKA).
This was a retrospective study performed over 15 y in a single Korean center. Children aged ≤18-y-old with T1DM and DKA were enrolled and divided into 2 groups according to the presence of AKI.
This study included 90 episodes of DKA in 58 children with T1DM. AKI occurred in a total of 70 hospitalizations (77.8%) of 44 children: 18 (20.0%) with stage 1 AKI, 39 (43.3%) with stage 2 AKI, and 13 (14.4%) with stage 3 AKI. The number of AKI decreased to 28 (47.4%) and 13 (28.3%) after 12 h and 24 h of admission, respectively. The white blood cell count (P = 0.001) and anion gap levels (P = 0.025) were significantly higher and serum bicarbonate level (P = 0.004) was lower in the AKI group. Logistic regression analysis revealed that a longer duration of TIDM and high anion gap were independent predictors of developing severe AKI in pediatric DKA with T1DM (odds ratio, 1.225, P = 0.013; odds ratio, 1.130, P = 0.038).
AKI frequently occurred in TIDM children with DKA. Longer duration of TIDM and elevated anion gap are associated with occurrence of severe AKI.
评估 1 型糖尿病（T1DM）合并糖尿病酮症酸中毒（DKA）患儿中急性肾损伤（AKI）的发生率和临床特征，并确定 AKI 的相关危险因素。
这是一项在韩国单一中心进行的 15 年回顾性研究。纳入年龄≤18 岁的 T1DM 合并 DKA 患儿，根据 AKI 的存在分为 2 组。
本研究共纳入 58 例 T1DM 患儿的 90 例 DKA 发作。共有 44 例患儿（77.8%）发生 70 例 AKI 住院：18 例（20.0%）为 1 期 AKI，39 例（43.3%）为 2 期 AKI，13 例（14.4%）为 3 期 AKI。入院 12 小时和 24 小时后 AKI 例数分别降至 28 例（47.4%）和 13 例（28.3%）。AKI 组白细胞计数（P = 0.001）和阴离子间隙水平（P = 0.025）显著升高，血清碳酸氢盐水平（P = 0.004）显著降低。Logistic 回归分析显示，T1DM 病程较长和高阴离子间隙是儿科 DKA 合并 T1DM 发生严重 AKI 的独立预测因素（比值比，1.225，P = 0.013；比值比，1.130，P = 0.038）。
T1DM 合并 DKA 患儿常发生 AKI。T1DM 病程较长和阴离子间隙升高与严重 AKI 的发生有关。
