Department of Woman, Child and of General and Specialized Surgery, Università della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy.
Department of Pediatrics, AORN Sant'Anna e San Sebastiano, via Ferdinando Palasciano, 81100, Caserta, Italy.
Pediatr Nephrol. 2021 Jun;36(6):1627-1635. doi: 10.1007/s00467-020-04834-7. Epub 2021 Jan 7.
We aimed to evaluate prevalence of acute kidney injury (AKI) and its risk factors in children hospitalized for acute gastroenteritis (AGE) to identify early predictors of AKI.
We retrospectively collected clinical and biochemical data of 114 children (57.9% male; mean age 2.9 ± 2.8 years) hospitalized for AGE. AKI was defined according to Kidney Disease/Improving Global Outcomes creatinine criteria. We considered basal serum creatinine as value of creatinine estimated with Hoste (age) equation assuming basal eGFRs were median age-based eGFR normative values for children ≤ 2 years of age, and eGFR 120 mL/min/1.73m for children > 2 years. Univariate and multivariate logistic regression models were used to explore associations with AKI. We included in multivariate analyses only variables with significant p after Bonferroni correction.
AKI was found in 28/114 (24.6%) patients. No patients required hemodialysis, 2 (1.8%) reached AKI stage 3, 2 (1.8%) AKI stage 2, and 24 (21.0%) AKI stage 1. Mean length of stay was 3.6 ± 1.2, 5.0 ± 1.8, and 10.5 ± 5.8 days, for patients with no, mild, and severe AKI (p < 0.001), respectively. Duration of symptoms before hospitalization (OR = 2.5; 95% CI = 1.3-5.0; p = 0.006), dehydration > 5% (OR = 43.1; 95% CI = 5.4-344.1; p = < 0.001), and serum bicarbonate levels (OR = 1.6; 95% CI = 1.2-2.1; p = 0.001) were independent predictors of AKI.
About one quarter of patients hospitalized for AGE may suffer from AKI with a longer stay for patients with more severe AKI. Particular attention, however, should be paid to volemia and kidney health of patients with AGE especially in the presence of increased duration of symptoms before hospitalization, dehydration, and lower serum bicarbonate levels.
本研究旨在评估因急性胃肠炎（AGE）住院的儿童中急性肾损伤（AKI）的患病率及其危险因素，以确定 AKI 的早期预测指标。
我们回顾性收集了 114 名（男 57.9%；平均年龄 2.9 ± 2.8 岁）因 AGE 住院的儿童的临床和生化数据。根据改善全球肾脏病预后组织（KDIGO）的肌酐标准定义 AKI。我们将基础血清肌酐视为用 Hoste（年龄）方程估算的肌酐值，假设基础 eGFR 为年龄<2 岁儿童的中位年龄基于 eGFR 的正常值，年龄>2 岁儿童的 eGFR 为 120 mL/min/1.73m。采用单变量和多变量逻辑回归模型探讨与 AKI 的关联。仅将 Bonferroni 校正后有显著 p 值的变量纳入多变量分析。
114 名患者中，28 名（24.6%）发生 AKI。无患者需要血液透析，2 名（1.8%）达到 AKI 3 期，2 名（1.8%）AKI 2 期，24 名（21.0%）AKI 1 期。无 AKI、轻度 AKI 和重度 AKI 患者的住院时间分别为 3.6 ± 1.2、5.0 ± 1.8 和 10.5 ± 5.8 天（p<0.001）。住院前症状持续时间（OR = 2.5；95%CI = 1.3-5.0；p = 0.006）、脱水>5%（OR = 43.1；95%CI = 5.4-344.1；p = <0.001）和血清碳酸氢盐水平（OR = 1.6；95%CI = 1.2-2.1；p = 0.001）是 AKI 的独立预测因素。
因 AGE 住院的患者中约有四分之一可能患有 AKI，且 AKI 越严重，患者的住院时间越长。然而，特别是对于住院前症状持续时间较长、脱水和血清碳酸氢盐水平较低的患者，应特别注意其血容量和肾脏健康。
