Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
Clin Exp Nephrol. 2023 Jun;27(6):548-556. doi: 10.1007/s10157-023-02339-9. Epub 2023 Mar 18.
There is paucity of information regarding the etiology and outcomes of Acute Kidney Disease (AKD) in children.
The objectives of this cohort study were to evaluate the etiology and outcomes of AKD; and analyze predictors of kidney survival (defined as free of CKD 2, 3a, 3b, 4 or 5). Patients aged 1 month to 18 years who developed AKD over a 4-year-period (January 2018-December 2021) were enrolled. Survivors were followed-up at the pediatric nephrology clinic, and screened for residual kidney injury.
Among 5710 children who developed AKI, 200 who developed AKD were enrolled. The median (IQR) eGFR was 17.03 (10.98, 28) mL/min/1.73 m. Acute glomerulonephritis, acute tubular necrosis (ATN), hemolytic uremic syndrome (HUS), sepsis-associated AKD, and snake envenomation comprised of 69 (34.5%), 39 (19.5%), 24 (12%), 23 (11.5%) and 15 (7.5%) of the patients respectively. Overall, 88 (44%) children required kidney replacement therapy (KRT). There were 37 (18.5%) deaths within the AKD period. At a follow-up of 90 days, 32 (16%) progressed to chronic kidney disease stage-G2 or greater. At a median (IQR) follow-up of 24 (6, 36.5) months (n = 154), 27 (17.5%) had subnormal eGFR, and 20 (12.9%) had persistent proteinuria and/or hypertension. Requirement of KRT predicted kidney survival (free of CKD 2, 3a, 3b, 4 or 5) in AKD (HR 6.7, 95% CI 1.2, 46.4) (p 0.04).
Acute glomerulonephritis, ATN, HUS, sepsis-associated AKD and snake envenomation were common causes of AKD. Mortality in AKD was 18.5%, and 16% progressed to CKD-G2 or greater at 90-day follow-up.
儿童急性肾损伤的病因和结局信息有限。
本队列研究的目的是评估 AKD 的病因和结局，并分析预测肾脏存活率的因素（定义为无慢性肾脏病 2、3a、3b、4 或 5）。研究纳入了在 4 年期间（2018 年 1 月至 2021 年 12 月）发生 AKD 的 1 个月至 18 岁的患者。幸存者在儿科肾病诊所接受随访，并筛查残留肾损伤。
在 5710 例发生 AKI 的儿童中，有 200 例发生 AKD 纳入研究。中位（IQR）eGFR 为 17.03（10.98，28）mL/min/1.73 m。急性肾小球肾炎、急性肾小管坏死（ATN）、溶血尿毒综合征（HUS）、败血症相关 AKD 和蛇咬伤分别占 69（34.5%）、39（19.5%）、24（12%）、23（11.5%）和 15（7.5%）的患者。总体而言，88（44%）例儿童需要肾脏替代治疗（KRT）。AKD 期间有 37（18.5%）例死亡。在 90 天的随访中，32（16%）例进展为慢性肾脏病 2 期或更高级别。中位（IQR）随访 24（6，36.5）个月（n=154）时，27（17.5%）例患者 eGFR 降低，20（12.9%）例患者存在持续性蛋白尿和/或高血压。KRT 的需求预测 AKD 的肾脏存活率（无慢性肾脏病 2、3a、3b、4 或 5）（HR 6.7，95%CI 1.2，46.4）（p=0.04）。
急性肾小球肾炎、ATN、HUS、败血症相关 AKD 和蛇咬伤是 AKD 的常见病因。AKD 死亡率为 18.5%，90 天随访时 16%进展为慢性肾脏病 2 期或更高级别。
