Sethi Sidharth Kumar, Sharma Rajesh, Gupta Aditi, Tibrewal Abhishek, Akole Romel, Dhir Rohan, Soni Kritika, Bansal Shyam Bihari, Jha Pranaw Kumar, Bhan Anil, Kher Vijay, Raina Rupesh
Department of Pediatric Nephrology, Kidney Institute, Medanta - The Medicity, Gurgaon, Haryana, India.
Pediatric Cardiac Intensive Care, Medanta - The Medicity, Gurgaon, Haryana, India.
Kidney Int Rep. 2021 Apr 28;6(7):1850-1857. doi: 10.1016/j.ekir.2021.04.018. eCollection 2021 Jul.
The long-term renal outcomes of survivors of pediatric acute kidney injury (AKI) are varied within the current literature, and we aim to establish long-term renal outcomes for pediatric patients after cardiac surgery. We studied long-term renal outcomes and markers of kidney injury in pediatric patients after congenital cardiac surgery.
In a prospective case-control observational study (the Renal Outcomes in Children with acute Kidney injury post cardiac Surgery [ROCKS] trial) we reviewed all children who underwent cardiac surgery on cardiopulmonary bypass (December 2010-2017).
During the study period, 2035 patients underwent cardiac surgery, of whom 9.8% developed AKI postoperatively. Forty-four patients who had postoperative AKI had a long-term follow-up, met our inclusion criteria, and were compared with 49 control subjects. We conducted a univariate analysis of reported parameters. At a median follow-up of 41 months, the cases had significantly higher urine levels of neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and kidney injury molecule-1 (KIM-1). The biomarkers remained higher after adjusting for the urine creatinine, and the ratio of urine KIM-1/urine creatinine was significantly higher among cases. None of the patients had proteinuria or hypertension on follow-up. The presence of AKI, AKI stage, and younger age were not associated with the occurrence of low glomerular filtration rate (GFR) at follow-up.
Urinary biomarker abnormalities persist years after a congenital cardiac surgery in children, who may have a low GFR on follow-up. The presence of AKI, AKI stage, and younger age at surgery are not associated with the occurrence of low GFR at follow-up. Children with a higher surgical complexity score have lower GFR on follow-up.
在当前文献中，小儿急性肾损伤（AKI）幸存者的长期肾脏预后各不相同，我们旨在确定心脏手术后小儿患者的长期肾脏预后。我们研究了先天性心脏手术后小儿患者的长期肾脏预后及肾损伤标志物。
在一项前瞻性病例对照观察性研究（心脏手术后急性肾损伤患儿的肾脏预后[ROCKS]试验）中，我们回顾了所有在体外循环下接受心脏手术的儿童（2010年12月至2017年）。
在研究期间，2035例患者接受了心脏手术，其中9.8%术后发生AKI。44例术后发生AKI的患者进行了长期随访，符合我们的纳入标准，并与49例对照受试者进行比较。我们对报告的参数进行了单因素分析。在中位随访41个月时，病例组中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、白细胞介素-18（IL-18）和肾损伤分子-1（KIM-1）的尿水平显著更高。在校正尿肌酐后，生物标志物仍较高，且病例组尿KIM-1/尿肌酐比值显著更高。随访期间所有患者均无蛋白尿或高血压。AKI的存在、AKI分期和较年轻的年龄与随访时低肾小球滤过率（GFR）的发生无关。
儿童先天性心脏手术后数年，尿生物标志物异常持续存在，这些儿童随访时GFR可能较低。AKI的存在、AKI分期和手术时较年轻的年龄与随访时低GFR的发生无关。手术复杂性评分较高的儿童随访时GFR较低。
