Division of Pediatric Nephrology, Dialysis, and Transplantation, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
Department of Pediatrics, Pediatric Nephrology, Indiana University Medical Center, Indianapolis, IN, USA.
Pediatr Nephrol. 2023 Sep;38(9):3109-3116. doi: 10.1007/s00467-023-05916-y. Epub 2023 Mar 21.
Acute kidney injury (AKI) in children has serious short-term and long-term consequences. We sought 1) to prospectively describe NSAID-associated AKI in hospitalized children; 2) to determine if NSAID-associated AKI was more severe in younger children < 5 years; and 3) to follow outcomes after hospitalization for NSAID-associated AKI.
This was a prospective, multi-center study in hospitalized children 1 month to 18 years. Parents/guardians were given a brief questionnaire to determine the dosing, duration, and type of NSAIDs given. Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria were used to stage AKI severity. Patients with other causes of AKI were excluded (e.g., other nephrotoxins, sepsis, malignancy, etc.).
We identified 25 patients with NSAID-associated AKI, accounting for 3.1% of AKI. All 25 had AKI upon hospital presentation. The median age was 15.5 years, and 20/25 (80%) had volume depletion. Median duration of NSAID use was 2 days, and 63% of patients took the normal recommended NSAID dose. Median hospital length of stay was 4 days, and none required dialysis. At the most recent estimated glomerular filtration rate (eGFR) after discharge (available in 17/25 patients), only 4/17 (24%) had eGFR ≥ 90 ml/min/1.73 m, and 13/17 (76%) had eGFR 60 to < 90 ml/min/1.73 m, indicative of abnormal kidney function.
NSAID-associated AKI usually occurs with recommended NSAID dosing in the setting of dehydration. Follow-up after AKI showed a substantial rate of CKD. Therefore, we recommend that NSAIDs should not be used in dehydrated children. A higher resolution version of the Graphical abstract is available as Supplementary information.
儿童急性肾损伤（AKI）具有严重的短期和长期后果。我们旨在：1）前瞻性描述住院儿童中 NSAID 相关性 AKI；2）确定<5 岁的儿童 NSAID 相关性 AKI 是否更严重；3）随访 NSAID 相关性 AKI 住院后的结局。
这是一项前瞻性、多中心研究，纳入 1 个月至 18 岁的住院患儿。家长/监护人需填写简短的调查问卷，以确定 NSAID 的剂量、使用时长和类型。采用肾脏病：改善全球预后（KDIGO）血清肌酐标准来分期 AKI 严重程度。排除其他原因引起 AKI 的患者（例如，其他肾毒物、脓毒症、恶性肿瘤等）。
我们共确定了 25 例 NSAID 相关性 AKI 患儿，占 AKI 患儿的 3.1%。所有 25 例患儿在入院时均存在 AKI。中位年龄为 15.5 岁，20/25（80%）例存在容量不足。NSAID 使用的中位时长为 2 天，63%的患儿使用了正常推荐剂量的 NSAID。中位住院时长为 4 天，无患儿需要透析。在出院后最近估计的肾小球滤过率（eGFR）（25 例患儿中 17 例可获得）中，仅有 4/17（24%）例患儿的 eGFR≥90ml/min/1.73m，13/17（76%）例患儿的 eGFR 为 60-<90ml/min/1.73m，提示存在肾功能异常。
通常情况下，在脱水状态下，推荐剂量的 NSAID 会导致 NSAID 相关性 AKI。AKI 后随访发现 CKD 的发生率较高。因此，我们建议在儿童脱水时避免使用 NSAID。
