Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, University of Delhi, New Delhi, India.
Saudi J Kidney Dis Transpl. 2021 Mar-Apr;32(2):437-444. doi: 10.4103/1319-2442.335456.
Children with nephrotic syndrome (NS) have a number of potential risk factors for the development of acute kidney injury (AKI) including intravascular volume depletion, infection, exposure to nephrotoxic medication, and renal interstitial edema. This study was aimed to determine the incidence of AKI in children hospitalized with a relapse of NS and its short-term outcome. This prospective observational study was conducted from February 2017 to January 2018 at a tertiary care teaching hospital. A total of 54 children and adolescents (1-18 years) hospitalized with a diagnosis of NS and relapse with/or without other complications were enrolled. Clinical data and examination were recorded. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria and Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (p-RIFLE) classification. Children who developed AKI during the first two weeks of hospitalization were followed up till recovery or six weeks whichever was earlier to determine the outcome and factors predisposing to AKI. The mean age of the study population was 59.5 months and 35 (64.8%) patients were male. Of the 54 patients hospitalized, 42 (77.8%) were admitted with infection-associated relapses while 22.2% of children had relapse alone. Diarrhea and spontaneous bacterial peritonitis were the most common infections (26.1% each) followed by urinary tract infections in 19% and pneumonia in 14.3%. Twenty-three (42.6%) children developed AKI according to the KDIGO definition and 27 (50%) using the pRIFLE classification. Fourteen (60.9%) had stage 2 AKI while 21.7% had stage 3 AKI. Infections [odds ratio (OR) 1.24] and use of angiotensin-converting enzyme inhibitors (ACEI) (OR 2.3) were the most common predisposing factors for AKI. The mean recovery time for AKI was 7.34 days. Development of AKI was associated with prolonged hospital stay (12.57 vs.8.55 days P <0.01) and delayed recovery. At the end of follow-up all children recovered from AKI. The incidence of AKI in children hospitalized with complications of NS is high. While the occurrence of these AKI episodes may appear transient, a recurrence of such episodes may be detrimental to the long-term outcome of children with NS. Infections and the use of ACEI during relapses are risk factor for the occurrence of AKI.
患有肾病综合征 (NS) 的儿童存在多种发生急性肾损伤 (AKI) 的潜在风险因素，包括血管内容量不足、感染、接触肾毒性药物和肾间质水肿。本研究旨在确定因 NS 复发住院的儿童中 AKI 的发生率及其短期预后。这是一项前瞻性观察研究，于 2017 年 2 月至 2018 年 1 月在一家三级教学医院进行。共纳入 54 名因 NS 复发住院且伴有或不伴有其他并发症的 1-18 岁青少年。记录临床资料和检查结果。AKI 的定义采用改善全球肾脏病预后组织 (KDIGO) 血清肌酐标准和儿科危险、损伤、衰竭、丧失、终末期肾脏疾病 (p-RIFLE) 分类。在住院的前两周内发生 AKI 的儿童将接受随访，直至恢复或 6 周，以确定结果和导致 AKI 的易感因素。研究人群的平均年龄为 59.5 个月，35 名（64.8%）患者为男性。在 54 名住院患者中，42 名（77.8%）因感染相关复发入院，而 22.2%的儿童单纯复发。腹泻和自发性细菌性腹膜炎是最常见的感染（各占 26.1%），其次是尿路感染占 19%，肺炎占 14.3%。根据 KDIGO 定义，有 23 名（42.6%）儿童发生 AKI，根据 pRIFLE 分类，有 27 名（50%）儿童发生 AKI。14 名（60.9%）为 2 期 AKI，21.7%为 3 期 AKI。感染（比值比 [OR] 1.24）和使用血管紧张素转换酶抑制剂（ACEI）（OR 2.3）是 AKI 最常见的易感因素。AKI 的平均恢复时间为 7.34 天。AKI 的发生与住院时间延长（12.57 天比 8.55 天，P<0.01）和恢复延迟有关。随访结束时，所有儿童的 AKI 均已恢复。在因 NS 并发症住院的儿童中，AKI 的发生率较高。虽然这些 AKI 发作的发生可能看起来是短暂的，但这种发作的再次发生可能对 NS 儿童的长期预后不利。复发时的感染和 ACEI 的使用是 AKI 发生的危险因素。
