Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong SAR, China.
Pediatr Nephrol. 2021 Oct;36(10):3251-3257. doi: 10.1007/s00467-021-05057-0. Epub 2021 Apr 13.
Our study aimed to determine the prevalence of acute kidney injury (AKI) in pediatric non-traumatic rhabdomyolysis, and to identify factors associated with its development.
Clinical information and laboratory tests of children with rhabdomyolysis who were admitted between 2009 and 2018 were reviewed retrospectively. Rhabdomyolysis was defined by a peak serum creatine kinase (CK) level > 1000 IU/L within the first 72 h of admission. The primary outcome was the occurrence of AKI within the first 7 days of admission, which was determined by the KDIGO criteria.
A total of 54 patients with a median age of 7.8 years old were included. Ten (18.5%) patients developed AKI. AKI was relatively rare in children with viral myositis (2.6%), whereas all patients with rhabdomyolysis related to seizure or irritability/dystonia developed AKI. Patients with AKI had higher white cell count (10.6 vs. 4.5 × 10/L) and lower serum bicarbonate (19.4 vs. 25.5 mmol/L) on admission, with higher peak serum CK (23,086.0 vs. 3959.5 IU/L). The AKI group was more likely to present with positive urine results (myoglobinuria, dipstick heme or protein ≥ 2+). Peak serum CK had a good discriminatory power for stage 2-3 AKI (AUC 0.930, p = 0.005), with an optimal cut-off of 15,000 IU/L identified from the ROC analysis.
The overall prevalence of AKI in pediatric non-traumatic rhabdomyolysis was 18.5%. Positive urine tests (myoglobinuria, dipstick heme or protein ≥ 2+), high white cell count, lower serum bicarbonate on admission, and high peak serum CK were associated with development of AKI.
本研究旨在确定儿科非创伤性横纹肌溶解症中急性肾损伤（AKI）的发生率，并确定其发生的相关因素。
回顾性分析 2009 年至 2018 年期间入院的横纹肌溶解症患儿的临床资料和实验室检查。横纹肌溶解症定义为入院 72 小时内血清肌酸激酶（CK）峰值>1000IU/L。主要结局为入院后 7 天内发生 AKI，采用 KDIGO 标准判断。
共纳入 54 例患儿，中位年龄为 7.8 岁。10 例（18.5%）患儿发生 AKI。病毒性肌炎患儿 AKI 发生率相对较低（2.6%），而所有与癫痫或易激惹/肌张力障碍相关的横纹肌溶解症患儿均发生 AKI。AKI 组患儿入院时白细胞计数较高（10.6 vs. 4.5×10/L），血清碳酸氢盐较低（19.4 vs. 25.5mmol/L），峰值血清 CK 较高（23086.0 vs. 3959.5IU/L）。AKI 组尿液结果更可能呈阳性（肌红蛋白尿、尿潜血或蛋白≥2+）。峰值血清 CK 对 2-3 期 AKI 有良好的鉴别能力（AUC 0.930，p=0.005），ROC 分析确定最佳截断值为 15000IU/L。
儿科非创伤性横纹肌溶解症中 AKI 的总体发生率为 18.5%。阳性尿液检查（肌红蛋白尿、尿潜血或蛋白≥2+）、白细胞计数高、入院时血清碳酸氢盐低、峰值血清 CK 高与 AKI 的发生相关。
