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Zhang J, Huang Z, Lin Q, Hu W, Zhong H, Zhang F, Huang J. The correlation between serum angiopoietin-2 levels and acute kidney injury (AKI): a meta-analysis. Clin Chem Lab Med 2024; 0:cclm-2024-0365. [PMID: 38915251 DOI: 10.1515/cclm-2024-0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION The correlation between serum angiopoietin-2 levels and acute kidney injury (AKI) is a topic of significant clinical interest. This meta-analysis aims to provide a comprehensive evaluation of this relationship. CONTENT A systematic search was conducted in PubMed, Embase, Web of Science, and Cochrane databases up to October 11, 2023. The included studies were evaluated using the Newcastle-Ottawa Scale (NOS) and Methodological Index for Non-Randomized Studies (MINORS). Weighted mean differences (WMD) and odds ratios (OR) were calculated using random-effects models. Sensitivity analysis, funnel plots, and Egger's test were used to assess the robustness and publication bias of the findings. Subgroup analyses were performed to explore potential variations between adults and children. SUMMARY Eighteen studies encompassing a total of 7,453 participants were included. The analysis revealed a significant elevation in serum angiopoietin-2 levels in patients with AKI compared to those without (WMD: 4.85; 95 % CI: 0.75 to 0.27; I²=93.2 %, p<0.001). Subgroup analysis indicated significantly higher angiopoietin-2 levels in adults with AKI (WMD: 5.17; 95 % CI: 3.51 to 6.83; I²=82.6 %, p<0.001), but not in children. Additionally, high serum angiopoietin-2 levels were associated with an increased risk of AKI (OR: 1.58; 95 % CI: 1.39 to 1.8; I²=89.1 %, p<0.001). Sensitivity analysis validated the robustness of these results, showing no substantial change in the overall effect size upon the exclusion of individual studies. OUTLOOK This meta-analysis supports a significant association between elevated serum angiopoietin-2 levels and increased risk of AKI. The observed differential association between adults and children highlights the need for further targeted research to understand these age-specific variations.
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Affiliation(s)
- Juncheng Zhang
- The School of Clinical Medicine, 74551 Fujian Medical University , Fuzhou, Fujian, China
| | - Zhengjie Huang
- The School of Clinical Medicine, 74551 Fujian Medical University , Fuzhou, Fujian, China
| | - Qin Lin
- The School of Clinical Medicine, 74551 Fujian Medical University , Fuzhou, Fujian, China
- Department of Nephrology, Xiamen Key Laboratory of Precision Diagnosis and Treatment of Chronic Kidney Disease, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
- Department of Nephrology, Fujian Clinical Research Center for Chronic Glomerular Disease, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Weiping Hu
- The School of Clinical Medicine, 74551 Fujian Medical University , Fuzhou, Fujian, China
- Department of Nephrology, Xiamen Key Laboratory of Precision Diagnosis and Treatment of Chronic Kidney Disease, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
- Department of Nephrology, Fujian Clinical Research Center for Chronic Glomerular Disease, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Hongbin Zhong
- The School of Clinical Medicine, 74551 Fujian Medical University , Fuzhou, Fujian, China
- Department of Nephrology, Xiamen Key Laboratory of Precision Diagnosis and Treatment of Chronic Kidney Disease, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
- Department of Nephrology, Fujian Clinical Research Center for Chronic Glomerular Disease, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Fengling Zhang
- The School of Clinical Medicine, 74551 Fujian Medical University , Fuzhou, Fujian, China
- Department of Nephrology, Xiamen Key Laboratory of Precision Diagnosis and Treatment of Chronic Kidney Disease, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
- Department of Nephrology, Fujian Clinical Research Center for Chronic Glomerular Disease, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jiyi Huang
- The School of Clinical Medicine, 74551 Fujian Medical University , Fuzhou, Fujian, China
- Department of Nephrology, Xiamen Key Laboratory of Precision Diagnosis and Treatment of Chronic Kidney Disease, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
- Department of Nephrology, Fujian Clinical Research Center for Chronic Glomerular Disease, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Ruutiainen H, Holmström AR, Kunnola E, Kuitunen S. Use of Computerized Physician Order Entry with Clinical Decision Support to Prevent Dose Errors in Pediatric Medication Orders: A Systematic Review. Paediatr Drugs 2024; 26:127-143. [PMID: 38243105 PMCID: PMC10891203 DOI: 10.1007/s40272-023-00614-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Prescribing is a high-risk task within the pediatric medication-use process and requires defenses to prevent errors. Such system-centric defenses include electronic health record systems with computerized physician order entry (CPOE) and clinical decision support (CDS) tools that assist safe prescribing. The objective of this study was to examine the effects of CPOE systems with CDS functions in preventing dose errors in pediatric medication orders. MATERIAL AND METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria and Synthesis Without Meta-Analysis (SWiM) items. The study protocol was registered in PROSPERO (CRD42021277413). The final literature search on MEDLINE (Ovid), Scopus, Web of Science, and EMB Reviews was conducted on 10 September 2023. Only peer-reviewed studies considering both CPOE and CDS systems in pediatric inpatient or outpatient settings were included. Study selection, data extraction, and evidence quality assessment (JBI critical appraisal tool assessment and GRADE approach) were carried out by two individual reviewers. Vote counting method was used to evaluate the effects of CPOE-CDS systems on dose errors rates. RESULTS A total of 17 studies published in 2007-2021 met the inclusion criteria. The most used CDS tools were dose range check (n = 14), dose calculator (n = 8), and dosing frequency check (n = 8). Alerts were recorded in 15 studies. A statistically significant reduction in dose errors was found in eight studies, whereas an increase of dose errors was not reported. CONCLUSIONS The CPOE-CDS systems have the potential to reduce pediatric dose errors. Most beneficial interventions seem to be system customization, implementing CDS alerts, and the use of dose range check. While human factors are still present within the medication use process, further studies and development activities are needed to optimize the usability of CPOE-CDS systems.
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Affiliation(s)
- Henna Ruutiainen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, PL 56, 00014, Helsinki, Finland.
- HUS Pharmacy, Helsinki University Hospital, Helsinki, Finland.
| | - Anna-Riia Holmström
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, PL 56, 00014, Helsinki, Finland
| | - Eva Kunnola
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, PL 56, 00014, Helsinki, Finland
| | - Sini Kuitunen
- HUS Pharmacy, Helsinki University Hospital, Helsinki, Finland
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Zhang M, Huang L, Zhu Y, Zeng L, Jia ZJ, Cheng G, Li H, Zhang L. Epidemiology of Vancomycin in Combination With Piperacillin/Tazobactam-Associated Acute Kidney Injury in Children: A Systematic Review and Meta-analysis. Ann Pharmacother 2024:10600280231220379. [PMID: 38279799 DOI: 10.1177/10600280231220379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND Several studies have shown that vancomycin combined with piperacillin/tazobactam (VPT) increased the risk of acute kidney injury (AKI) compared with other antibiotics in children. However, the epidemiology of VPT-associated AKI in children is unknown. OBJECTIVE To evaluate the incidence and risk factors of VPT-associated AKI in children. DATA SOURCES Literature databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Database, WanFang Database, and China Biology Medicine Disc were searched from inception to November 2023. References of included studies were also manually checked. STUDY SELECTION AND DATA EXTRACTION Two independent reviewers selected studies, extracted data, and quality assessment. Meta-analyses were performed to quantify the incidence and risk factors of VPT-associated AKI in children. DATA SYNTHESIS Sixteen cohort studies were identified. Overall, the incidence of VPT-associated AKI in children was 24.3% (95% CI: 17.9%-30.6%). The incidence of VPT-associated AKI in critically ill children (26.6%) was higher than that in noncritically ill children (10.9%). Moreover, higher serum vancomycin trough concentration (>15 mg/L), use of vasopressors, combination of nephrotoxins and intensive care unit admission were risk factors for VPT-associated AKI in children (P < 0.05). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Identifying high-risk groups and determining safer treatments is critical to reducing the incidence of VPT-associated AKI in children. CONCLUSIONS The incidence of VPT-associated AKI in children is high, especially in critically ill children. Medication regimens should be personalized based on the presence of individual risk factors. Moreover, renal function was regularly assessed throughout treatment with VPT.
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Affiliation(s)
- Miao Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Liang Huang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yu Zhu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Zhi-Jun Jia
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Guo Cheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Sichuan University, Chengdu, China
| | - Hailong Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
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Ferrari CR, Lopes CE, Belangero VMS. Pediatric nephrologist-intensivist interaction in acute kidney injury. J Bras Nefrol 2024; 46:70-78. [PMID: 37115039 PMCID: PMC10962412 DOI: 10.1590/2175-8239-jbn-2022-0158en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/23/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Acute Kidney Injury (AKI) in the Intensive Care Unit (ICU) have concepts of diagnosis and management have water balance as their main point of evaluation. In our ICU, from 2004 to 2012, the nephrologist's participation was on demand only; and as of 2013 their participation became continuous in meetings to case discussion. The aim of this study was to establish how an intense nephrologist/intensivist interaction influenced the frequency of dialysis indication, fluid balance and pRIFLE classification during these two observation periods. METHODS Retrospective study, longitudinal evaluation of all children with AKI undergoing dialysis (2004 to 2016). PARAMETERS STUDIED frequency of indication, duration and volume of infusion in the 24 hours preceding dialysis; diuresis and water balance every 8 hours. Non-parametric statistics, p ≤ 0.05. RESULTS 53 patients (47 before and 6 after 2013). There were no significant differences in the number of hospitalizations or cardiac surgeries between the periods. After 2013, there was a significant decrease in the number of indications for dialysis/year (5.85 vs. 1.5; p = 0.000); infusion volume (p = 0.02), increase in the duration of dialysis (p = 0.002) and improvement in the discrimination of the pRIFLE diuresis component in the AKI development. CONCLUSION Integration between the ICU and pediatric nephrology teams in the routine discussion of cases, critically approaching water balance, was decisive to improve the management of AKI in the ICU.
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Affiliation(s)
- Cassio Rodrigues Ferrari
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Departamento de Pediatria, Campinas, SP, Brazil
| | - Carlos Eduardo Lopes
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Departamento de Pediatria, Campinas, SP, Brazil
| | - Vera Maria Santoro Belangero
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Departamento de Pediatria, Campinas, SP, Brazil
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Zhang M, Lang B, Li H, Huang L, Zeng L, Jia ZJ, Cheng G, Zhu Y, Zhang L. Incidence and risk factors of drug-induced kidney injury in children: a systematic review and meta-analysis. Eur J Clin Pharmacol 2023; 79:1595-1606. [PMID: 37787852 DOI: 10.1007/s00228-023-03573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To comprehensively summarize the incidence and risk factors of drug-induced kidney injury (DIKI) in children. METHODS We systematically searched seven databases from inception to November 2022. Two independent reviewers selected studies, extracted data, and assessed the risk of bias. Meta-analyses were conducted to quantify the incidence and risk factors of DIKI in children. RESULTS A total of 69 studies comprising 195,894 pediatric patients were included. Overall, the incidence of DIKI in children was 18.2% (95%CI: 16.4%-20.1%). The incidence of DIKI in critically ill children (19.6%, 95%CI: 15.9%-23.3%) was higher than that in non-critically ill children (16.1%, 95%CI: 12.9%-19.4%). Moreover, the risk factors for DIKI in children were intensive care unit (ICU) admission (OR = 1.59, 95% CI: 1.42-1.78, P = 0.000), treatment days (OR = 1.04, 95% CI: 1.03-1.05, P = 0.000), surgical intervention (OR = 1.43, 95% CI: 1.00-2.02, P = 0.048), infection (OR = 2.30, 95% CI: 1.44-3.66, P = 0.000), patent ductus arteriosus (OR = 4.78, 95% CI: 1.82-12.57, P = 0.002), chronic kidney disease (OR = 2.78, 95% CI: 1.92-4.02, P = 0.000), combination with antibacterial agents (OR = 1.98, 95% CI: 1.54-2.55, P = 0.000), diuretics (OR = 1.97, 95% CI: 1.51-2.56, P = 0.000), combination with antiviral agents (OR = 1.50, 95% CI: 1.11-2.04, P = 0.008), combination with non-steroidal anti-inflammatory drugs (OR = 1.79, 95% CI: 1.40-2.28, P = 0.000), and combination with immunosuppressive agents (OR = 2.84, 95% CI: 1.47-5.47, P = 0.002). CONCLUSION The incidence of DIKI in children is high, especially in critically ill children. Identifying high-risk groups and determining safer treatments is critical to reducing the incidence of DIKI in children. In clinical practice, clinicians should adjust medication regimens for high-risk pediatric groups, such as ICU admission, some underlying diseases, combination with nephrotoxic drugs, etc., and regularly evaluate kidney function throughout treatment.
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Affiliation(s)
- Miao Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Bingchen Lang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Hailong Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Liang Huang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Zhi-Jun Jia
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Guo Cheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Sichuan University, Chengdu, China
| | - Yu Zhu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China.
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China.
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
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Zhang M, Li H, Huang L, Liu Y, Jiao XF, Zeng L, Jia ZJ, Cheng G, Zhang L, Zhang W. Drug-associated kidney injury in children: a disproportionality analysis of the FDA Adverse Event Reporting System. Eur J Pediatr 2023; 182:4655-4661. [PMID: 37561197 DOI: 10.1007/s00431-023-05146-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
Drug-associated kidney injury is related to longer hospitalization and increased risk of chronic kidney disease and mortality. However, there is currently a lack of large population studies on drug-associated kidney injury in children. This study aimed to study perform data mining to generate hypotheses on drugs, which may deserve to be assessed as per their potential risk of increasing kidney injury in children. We extracted and analyzed reports on drugs associated with kidney injury in children in the FDA Adverse Event Reporting System (FAERS). We conducted a disproportionality analysis using proportional reporting ratio (PRR) to evaluate the association between drugs and kidney injury in children. Meanwhile, comparisons were performed with drug labels to identify drugs that, despite not having kidney injury currently mentioned in their labels, may potentially be associated with risks of kidney injury in children. A total of 6347 children had drug-associated kidney injury in the FAERS database. The top five drugs with the highest PRR were gentamicin (PRR = 12.28, N = 157 cases, Chi-Squared = 1602.77), piperacillin-tazobactam (PRR = 9.77, N = 129 cases, Chi-Squared = 1003.24), amlodipine (PRR = 8.98, N = 271 cases, Chi-Squared = 1861.46), vancomycin (PRR = 8.91, N = 295 cases, Chi-Squared = 1998.64), and ceftriaxone (PRR = 8.00, N = 251 cases, Chi-Squared = 1494.02). According to drug labels, 9 drugs (9/30) were classified as potential nephrotoxins. CONCLUSIONS Approximately one-third of drugs associated with kidney injury in children do not list kidney injury as a side effect in their drug labels. Future studies are therefore warranted to evaluate whether these drugs are associated with such a risk. WHAT IS KNOWN • Nephrotoxic drugs are an increasingly common cause of acute kidney injury in hospitalized children. • Currently, no study has systematically combed drugs associated with kidney injury in children. WHAT IS NEW • Approximately a third of drugs showing signals for potential kidney injury in children in data mining do not mention this side effect in their drug labels. • This study provides data on drugs needing further study to determine whether they might increase the risk of kidney injury in children.
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Affiliation(s)
- Miao Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Hailong Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Liang Huang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Yan Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Xue-Feng Jiao
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Zhi-Jun Jia
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Guo Cheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Sichuan University, Chengdu, China
| | - Lingli Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.
- Medical Big Data Center, Sichuan University, Chengdu, China.
| | - Wei Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.
- NMPA Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China.
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
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Abouhadid MA, Gawad TAA, Gebaly HHE, Abdallah AA, Refay ASE, Helmy NM, Allam AM. Urinary tissue inhibitor of metalloproteinase-2 as an early predictor for acute kidney injury in critically ill children. Int J Health Sci (Qassim) 2023; 17:22-28. [PMID: 37416842 PMCID: PMC10321466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Objectives Acute kidney injury (AKI) is one of the most devastating complications of critical illness in children. Serum creatinine (Scr) is considered the gold standard for AKI diagnosis yet noted to be late and inaccurate. This raises the need for an early and accurate biochemical parameter for the early detection of AKI. This research aimed to explore the role of urinary tissue inhibitor metalloproteinase 2 (TIMP-2) in the early prediction of AKI, compared to standard biomarkers, in critically ill children admitted to pediatric intensive care unit (PICU). Urine TIMP2 was previously explored in multiple adult studies and showed promising results; however, the study of its role in pediatric population was limited. Methods This study was a prospective cohort study including 42 critically ill children who are at increased risk of AKI. Cases were recruited from the PICU in the Children's Hospital of Ain-Shams University, Cairo - Egypt over 10 months' duration. Urine samples were collected to measure urinary TIMP-2 and blood samples were taken to measure the levels of Scr, creatinine clearance, and blood urea nitrogen. Urine output in 24 h was also calculated. Results Urinary TIMP-2 showed considerably higher levels in AKI compared to non-AKI patients as early as day 1, whereas increased levels of Scr and decreased urine output were noticed later (day 3 and day 5, respectively). A notable correlation existed between TIMP-2 at day 1 and creatinine at day 3. Conclusion The present study revealed that urinary TIMP-2 could have an important role in the early prediction of AKI before the increase in Scr and more deterioration in kidney functions.
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Affiliation(s)
- Maha A. Abouhadid
- Department of Child Health, Primary: National Research Centre, Giza, Egypt
- Department of Paediatrics, Arrowe Park Hospital, Wirral, UK
| | - Tarek A. Abdel Gawad
- Children’s Hospital, Ain-Shams University, Paediatric Intensive Care Unit, Cairo, Egypt
| | | | - Azza A. Abdallah
- Department of Child Health, National Research Centre, Giza, Egypt
| | | | - Neveen M. Helmy
- Department of Clinical Pathology, National Research Centre, Giza, Egypt
| | - Ahmad M. Allam
- Children’s Hospital, Ain-Shams University, Paediatric Intensive Care Unit, Cairo, Egypt
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Hoseini azad SA, Moshiri M, Roohbakhsh A, Shakeri A, Fatemi Shandiz A, Etemad L. Efficacy of orally administered montmorillonite in myoglobinuric acute renal failure model in male rats. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2023; 26:753-759. [PMID: 37396944 PMCID: PMC10311980 DOI: 10.22038/ijbms.2023.67985.14866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/20/2023] [Indexed: 07/04/2023]
Abstract
Objectives Acute kidney injury can be associated with serious consequences and therefore early treatment is critical to decreasing mortality and morbidity rate. We evaluated the effect of montmorillonite, the clay with strong cation exchange capacity, on the AKI model in rats. Materials and Methods Glycerol (50% solution, 10 ml/kg) was injected in the rat hind limbs to induce AKI. 24 hr after induction of acute kidney injury, the rats received oral doses of montmorillonite (0.5 g/kg or 1 g/kg), or sodium polystyrene sulfonate (1 g/kg) for three consecutive days. Results Glycine induced acute kidney injury in rats with high levels of urea (336.60± 28.19 mg/dl), creatinine (4.10± 0.21 mg/dl), potassium (6.15 ± 0.28 mEq/L), and calcium (11.52 ± 0.19 mg/dl). Both doses of montmorillonite (0.5 and 1 g/kg) improved the serum urea (222.66± 10.02 and 170.20±8.06, P<0.05), creatinine (1.86±0.1, 2.05± 0.11, P<0.05), potassium (4.68 ± 0.4, 4.73 ± 0.34, P<0.001) and calcium (11.15 ± 0.17, 10.75 ± 0.25, P<0.01) levels. Treatment with montmorillonite especially at a high dose reduced the kidney pathological findings including, tubular necrosis, amorphous protein aggregation, and cell shedding into the distal and proximal tubule lumen. However, administration of SPS could not significantly decrease the severity of damages. Conclusion According to the results of this study, as well as the physicochemical properties of montmorillonite, such as high ion exchange capacity and low side effects, montmorillonite can be a low-cost and effective treatment option to reduce and improve the complications of acute kidney injury. However, the efficacy of this compound in human and clinical studies needs to be investigated.
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Affiliation(s)
| | - Mohammad Moshiri
- Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Clinical Toxicology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Roohbakhsh
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abolfazl Shakeri
- Department of Pharmacognosy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Leila Etemad
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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9
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Ahmadi A, Shariatmadari F, Yousefichaijan P, Sarmadian R, Dorreh F, Arjmand Shabestari A. Evaluation of Renal Function and Urinalysis in Children With Simple Febrile Convulsions. Clin Pediatr (Phila) 2022:99228221142127. [PMID: 36476164 DOI: 10.1177/00099228221142127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Febrile convulsion (FC) is the most prevalent type of seizure in children. Febrile diseases have been associated with alterations in kidney function and urine indices. Therefore, in this study, renal function and urine analysis were examined in children with simple FC. The study comprised children with simple FC who were referred to the Amirkabir hospital in Arak between 2020 and 2021. Children were examined for urinalysis and kidney function by assessing the estimated glomerular filtration rate (eGFR). A total of 157 patients with FC were admitted. Hematuria, proteinuria, and pyuria were detected in 8.9%, 1.9%, and 5.1% of cases, respectively. The urine cultures of 2 children were positive. Moreover, it was found that in simple FC, eGFR decreases regardless of gender (P > .05), although kidney function decreases more in children older than 24 months. In conclusion, all children with FC must undergo renal function assessments. Furthermore, urinalysis and urine culture are advised to rule out infection.
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Affiliation(s)
| | | | | | - Roham Sarmadian
- Infectious Disease Research Center, Arak University of Medical Sciences, Arak, Iran
| | - Fatemeh Dorreh
- Department of Pediatrics, Arak University of Medical Sciences, Arak, Iran
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10
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Muacevic A, Adler JR. Determinants of Acute Kidney Injury in Children Undergoing Cardiopulmonary Bypass: Single-Center Experience in Saudi Arabia. Cureus 2022; 14:e32666. [PMID: 36540319 PMCID: PMC9760221 DOI: 10.7759/cureus.32666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Cardiopulmonary bypass (CPB) is a machine used in open cardiac surgeries and has been linked to many complications, one of which is acute kidney injury (AKI). Also, the Kidney Disease Improving Global Outcomes (KDIGO) criteria are used to diagnose AKI in the pediatric population. The study aimed to investigate the association between cardiopulmonary bypass duration and renal function impairment in pediatric patients who had cardiac surgery. Methods This was an observational, cross-sectional study conducted at the King Abdulaziz Medical City, King Faisal Cardiac Center, the section of the Pediatric Cardiac Intensive Care Unit (PICU), Ministry of National Guard Health Affairs, from January 2016 to December 2019. Patients younger than 14 years old, those having a cardiac surgery where CPB was implemented, normal pre-operative kidney functions, and having a cardiac surgery longer than 60 minutes (min) were included. The exclusion criteria were patients known to have pre-operative renal impairment and patients with pre-operative hemodynamic instability or cardiac arrest. Demographics of pre-operative, intra-operative, and post-operative data were extracted, and Statistical Package for the Social Sciences (SPSS) version 25 (Armonk, NY: IBM Corp.) was used for analysis. For descriptive statistics, frequencies and percentages for qualitative data were examined, while mean and standard deviation (SD) or median and interquartile range (IQR) quantitative data were used accordingly. Student's t-test, Mann-Whitney (median test), chi-square, or Fisher's exact tests were used for univariate analysis accordingly. Logistic regression analysis was used to determine significant predictors for developing AKI. A p-value of <0.05 would be considered significant. Results Of the 111 patients, 87 patients were included in the analysis. The median age was six months, IQR two to 13 months, body mass index (BMI) mean of 13.8, and SD 3.6. There was similar sex distribution, male 47.1% vs. female 52.9%. There were no patients in Risk Adjustment for Congenital Heart Surgery (RACHS) who scored 5 or 6. The AKI prevalence was 31% (27/87) within three days after surgery. One patient had stage 2 AKI; the rest were mild. One patient (3.7%) died. The CPB time was significantly longer in patients who developed AKI 150 (104-202), vs. non-AKI 104 (82-142) min, p=0.004. In the AKI group, the mean baseline (pre-operative) serum creatinine (sCr) was significantly lower, whereas, it was significantly higher at 24 hours (h), and 48 h post-operation (p=0.001, 0.001, and 0.036, respectively). Additionally, the estimated Glomerular Filtration Rate (eGFR) was significantly higher in the AKI group at 24 h (p=0.007). In logistical regression analysis, CPB time (per min unit time) was a significant predictor for developing AKI, OR 1.015, p=0.011 as a measured outcome. However, only CPB time >180 min was highly significant with OR 16.2, p=00.6 compared to CPB time 121-180 min OR 2.3, p=0.29 and CPB time 91-120 min OR 1.2, p=0.84. Conclusion Acute kidney injury is an expected complication of pediatric congenital heart surgery receiving CPB. Although in our single-center experience, CPB duration was a significant predictor for AKI; however, it is considered a mild complication that does not contribute significantly to short-term morbidity or mortality. A larger multicenter, national prospective data registry is recommended to explore long-term effects.
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11
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Sabry MM, Ahmed MM, Maksoud OMA, Rashed L, Morcos MA, El-Maaty AA, Maher Galal A, Sharawy N. Carnitine, apelin and resveratrol regulate mitochondrial quality control (QC) related proteins and ameliorate acute kidney injury: role of hydrogen peroxide. Arch Physiol Biochem 2022; 128:1391-1400. [PMID: 32538173 DOI: 10.1080/13813455.2020.1773504] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mitochondrial impairment is recognised as a prominent feature in kidney diseases. Therefore, we investigated whether the effects of resveratrol, L-carnitine, and apelin in the acute kidney injury model were associated with modulation of mitochondrial quality control (QC) related proteins, intra-renal renin-angiotensin (RAS) activity, adenosine triphosphate (ATP) and Na+-K+ ATPase gene expression. Rats were randomly assigned to 7 groups: Distilled water injected control group, DMSO injected control group, distilled water injected lipopolysaccharide (LPS) group, DMSO injected LPS group, resveratrol injected LPS group, L-carnitine injected LPS group and apelin 13 injected LPS group. We observed that resveratrol, L-carnitine, and apelin treatments altered mitochondrial (QC) related protein levels (Pink1, Parkin, BNIP-3, Drp1, and PGC1α), decreased intra-renal RAS parameters, increased ATP level and upregulated Na+-K+ ATPase gene expression in renal tissue. Our results provide new insight into the role of mitochondrial quality control and how different antioxidants exert beneficial effects on acute kidney injury.
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Affiliation(s)
- Maha Mohamed Sabry
- Department of Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona Mohamed Ahmed
- Department of Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Laila Rashed
- Department of Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mary Attia Morcos
- Department of Histology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amal Abo El-Maaty
- Department of Animal Reproduction and Artificial Insemination, Veterinary Division, National Research Centre, Cairo, Egypt
| | - Amr Maher Galal
- Department of Pharmacology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nivin Sharawy
- Department of Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of physiology, Cairo University Hospitals, Cairo, Egypt
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12
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Ruas AFL, Lébeis GM, de Castro NB, Palmeira VA, Costa LB, Lanza K, Simões E Silva AC. Acute kidney injury in pediatrics: an overview focusing on pathophysiology. Pediatr Nephrol 2022; 37:2037-2052. [PMID: 34845510 DOI: 10.1007/s00467-021-05346-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 01/12/2023]
Abstract
Acute kidney injury (AKI) is defined as an abrupt decline in glomerular filtration rate, with increased serum creatinine and nitrogenous waste products due to several possible etiologies. Incidence in the pediatric population is estimated to be 3.9 per 1,000 hospitalizations, and prevalence among children admitted to intensive care units is 26.9%. Despite being a condition with important incidence and morbimortality, further evidence on pathophysiology and management among the pediatric population is still lacking. This narrative review aimed to summarize and discuss current data on AKI pathophysiology in the pediatric population, considering all the physiological particularities of this age range and common etiologies. Additionally, we reported current diagnostic tools, novel biomarkers, and newly proposed medications that have been studied with the aim of early diagnosis and appropriate treatment of AKI in the future.
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Affiliation(s)
- Ana Flávia Lima Ruas
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Gabriel Malheiros Lébeis
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Nicholas Bianco de Castro
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Vitória Andrade Palmeira
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Larissa Braga Costa
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Katharina Lanza
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Alfredo Balena Avenue, Number 190, 2nd floor, Room #281, Belo Horizonte, MG, 30130100, Brazil.
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13
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Alexander E, Weatherhead J, Creo A, Hanna C, Steien DB. Fluid management in hospitalized pediatric patients. Nutr Clin Pract 2022; 37:1033-1049. [PMID: 35748381 DOI: 10.1002/ncp.10876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/28/2022] [Accepted: 05/21/2022] [Indexed: 11/09/2022] Open
Abstract
The proper use of intravenous fluids has likely been responsible for saving more lives than any other group of substances. Proper use includes prescribing an appropriate electrolyte and carbohydrate solution, at a calculated rate or volume, for the right child, at the right time. Forming intravenous fluid plans for hospitalized children requires an understanding of water and electrolyte physiology in healthy children and how different pathology deviates from the norm. This review highlights fluid management in several disease types, including liver disease, diabetic ketoacidosis, syndrome of inappropriate antidiuretic hormone, diabetes insipidus, kidney disease, and intestinal failure as well as in those with nonphysiologic fluid losses. For each disease, the review discusses specific considerations, evaluations, and management strategies to consider when customizing intravenous fluid plans. Ultimately, all hospitalized children should receive an individualized fluid plan with recurrent evaluations and fluid modifications to provide optimal care.
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Affiliation(s)
- Erin Alexander
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatric and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, Minnesota, USA.,Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey Weatherhead
- Division of Pediatric Critical Care, Department of Pediatric and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, Minnesota, USA
| | - Ana Creo
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, Minnesota, USA
| | - Christian Hanna
- Division of Pediatric Nephrology and Hypertension, Department of Pediatric and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, Minnesota, USA.,Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic Children's Center, Rochester, Minnesota, USA
| | - Dana B Steien
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatric and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, Minnesota, USA
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Dewi MM, Risan NA, Rachmadi D. Neutrophil Gelatinase-Associated Lipocalin Profile in Critically Ill Patients with Decreased of Consciousness. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background
Neutrophil Gelatinase-Associated Lipocalin (NGAL) is an early marker of renal tubules damage. In critically ill patients,there are significant oxygenation disruptions to many organs particularly the kidneys and the brain. Early recognition of renal abnormalities in patients with a decreased of consciousness may improve the outcomes of these patients.
Objective
To observe the profile of Neutrophil Gelatinase-Associated Lipocalin in critically ill children with a decreased level of consciousness in Hasan Sadikin Hospital Bandung.
Method
A cross-sectional study was performed on critically ill children with a decreased of consciousness in Hasan Sadikin Hospital, Bandung.
Result
Fifty-nine patients aged 2-15 years old were included in the study. There were thirty-seven males (62.7%) and twenty-two females (37.2%). In this study, all critically ill patients had elevated urinary NGAL levels with an average value of 606.95 ng/mL (1.20 -24629.59 ng/mL). We found that 30% of these patients developed sepsis caused by various etiologies which mostly were malignancy in 22 patients (37.3%) and pneumonia in 14 patients (23.7%). Of all the patients, 16.9% showed clinical improvement.
Summary
Neutrophil Gelatinase-Associated Lipocalin level is elevated in critically ill patients with a decreased of consciousness.
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Bai S, Moorani KN, Naeem B, Ashfaq M, . R, Rehman EU. Etiology, Clinical Profile, and Short-Term Outcome of Children With Acute Kidney Injury. Cureus 2022; 14:e22563. [PMID: 35378027 PMCID: PMC8958123 DOI: 10.7759/cureus.22563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Acute kidney injury (AKI) is a common clinical syndrome in hospitalized children and it imposes heavy burden of mortality and morbidity. In resource-constraint settings, management of AKI is very challenging and associated with adverse outcomes. The aim of this study was to determine the clinico-etiological profile and outcome of AKI. Methodology: This prospective observational study was done at the department of pediatric nephrology and pediatric intensive care unit, National Institute of Child Health, Karachi, Pakistan from December 2020 to May 2021. A total of 130 children aged 1 month to 15 years, diagnosed with AKI irrespective of the underlying cause were included. Detailed medical information of each child including medical history, examination, and baseline investigations were obtained. Clinical and etiological profile of patients was noted. The patients were followed up to three months and the outcome was noted. Results: In a total of 130 children, 82 (63.1%) were male. The mean age was 5.5±4.4 years (ranging between 1 month and 15 years). There were 117 (90.0%) children who were referred from other centers for either dialysis or surgical treatment. Prerenal cause of AKI was found in 66 (50.8%) children, followed by renal 53 (40.8%) and postrenal in 11 (8.5%) cases. Fever and shortness of breath were the most common clinical presenting symptoms in 102 (78.5%) and 100 (76%) cases, respectively. There were 45 (34.6%) cases who were managed conservatively, 80 (61.5%) needed dialysis, while three children were managed with plasmapheresis and two required surgical intervention in the emergency department. At three-month follow-up period, 64 (49.2%) children recovered (including nine with partial recovery), 46 (36.1%) expired, 9 (6.9%) developed end-stage renal disease, while 11 (8.5%) had chronic kidney disease. Conclusion: Sepsis, nephrotoxic drugs, and acute glomerulonephritis were the major causes of AKI at our center. Mortality was high among children presenting with AKI. A relatively high proportion of children with younger age, septic AKI, and presentation in critical condition could be the reasons for this high mortality.
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Risk Factors and Consequences of Acute Kidney Injury After Noncardiac Surgery in Children. Anesth Analg 2022; 135:625-632. [PMID: 35086116 DOI: 10.1213/ane.0000000000005901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Postoperative acute kidney injury (AKI) is a serious complication that is associated with prolonged hospital stay, high risk of short-term postsurgical mortality, need for dialysis, and possible progression to chronic kidney disease. To date, very little data exist on the risk of postoperative AKI among children undergoing noncardiac surgical procedures. We used data from a large multicenter cohort to determine the factors associated with AKI among children who underwent inpatient noncardiac surgical procedures and its impact on the postoperative course. METHODS We utilized the National Surgical Quality Improvement Program Pediatric participant user files to identify a cohort of children who underwent inpatient surgery between 2012 and 2018 (n = 257,439). We randomly divided the study population into a derivation cohort of 193,082 (75%) and a validation cohort of 64,357 (25%), and constructed a multivariable logistic regression model to identify independent risk factors for AKI. We defined AKI as the occurrence of either acute renal failure or progressive renal insufficiency within the 30 days after surgery. RESULTS The overall rate of postoperative AKI was 0.10% (95% confidence interval [CI], 0.09-0.11). In a multivariable model, operating times longer than 140 minutes, preexisting hematologic disorder, and preoperative sepsis were the strongest independent predictors of AKI. Other independent risk factors for AKI were American Society of Anesthesiologists (ASA) physical status ≥III, preoperative inotropic support, gastrointestinal disease, ventilator dependency, and corticosteroid use. The 30-day mortality rate was 10.1% in children who developed AKI and 0.19% in their counterparts without AKI (P < .001). Children who developed AKI were more likely to require an extended hospital stay (≥75th percentile of the study cohort) relative to their peers without AKI (77.4% vs 21.0%; P < .001). CONCLUSIONS Independent preoperative risk factors for AKI in children undergoing inpatient noncardiac surgery were hematologic disorder, preoperative sepsis, ASA physical status ≥III, inotropic support, gastrointestinal disease, ventilator dependency, and steroid use. Children with AKI were 10 times more likely to die and nearly 3 times more likely to require an extended hospital stay, relative to their peers without AKI.
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Satalkar V, Swamy KV. Pathophysiology of acute kidney injury on a molecular level: A brief review. MGM JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/mgmj.mgmj_161_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Qureshi R, Imtiaz S, Dhrolia M, Ahmad A. Frequency and etiology of tubulo-interstitial nephritis in an adult renal biopsies in a tertiary renal care hospital: A single-center study. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2021; 31:335-341. [PMID: 32394905 DOI: 10.4103/1319-2442.284007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tubulo-interstitial nephritis (TIN) is an important cause of acute renal failure which may progresses to chronic kidney disease (CKD). TIN is often under diagnosed with there are no specific signs and symptoms. As this entity has paramount importance, so we evaluated the frequency and etiological of TIN both acute TIN (ATIN) and chronic tububulo-interstitial nephritis (CTIN) in renal biopsies. This is a retrospective observational, descriptive study carried out in the Department of Nephrology at The Kidney Centre Post Graduate Training Institute from 2004 to 2016. A total of 1560 adult renal biopsies were done during this period with 125 biopsies of TIN, of which 70 (56%) cases were ATIN and 55 (44%), were CTIN. Thirty-eight (30%) patients had a history of taking proton-pump inhibitors, use of various antibiotics in 21 (16%) cases, and 11 (8%) patients had a history of taking Hakeemi (traditional healer using herbs and sometimes trace amounts of heavy metals) medications. The incidence of TIN is higher than suspected and can be caused by variety of etiological agents. Therefore, clinical awareness will help in the diagnosis and early identification of the disease.
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Affiliation(s)
- Ruqaya Qureshi
- Department of Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, Pakistan
| | - Salman Imtiaz
- Department of Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, Pakistan
| | - Murtaza Dhrolia
- Department of Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, Pakistan
| | - Aasim Ahmad
- Department of Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, Pakistan
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Melhem N, Rasmussen P, Joyce T, Clothier J, Reid CJD, Booth C, Sinha MD. Acute kidney injury in children with chronic kidney disease is associated with faster decline in kidney function. Pediatr Nephrol 2021; 36:1279-1288. [PMID: 33108507 PMCID: PMC8009790 DOI: 10.1007/s00467-020-04777-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/04/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to investigate the association of acute kidney injury (AKI) with change in estimated glomerular filtration rate (eGFR) in children with advanced chronic kidney disease (CKD). METHODS Single centre, retrospective longitudinal study including all prevalent children aged 1-18 years with nondialysis CKD stages 3-5. Variables associated with CKD were analysed for their potential effect on annualised eGFR change (ΔGFR/year) following multiple regression analysis. Composite end-point including 25% reduction in eGFR or progression to kidney replacement therapy was evaluated. RESULTS Of 147 children, 116 had at least 1-year follow-up in a dedicated CKD clinic with mean age 7.3 ± 4.9 years with 91 (78.4%) and 77 (66.4%) with 2- and 3-year follow-up respectively. Mean eGFR at baseline was 29.8 ± 11.9 ml/min/1.73 m2 with 79 (68%) boys and 82 (71%) with congenital abnormalities of kidneys and urinary tract (CAKUT). Thirty-nine (33.6%) had at least one episode of AKI. Mean ΔGFR/year for all patients was - 1.08 ± 5.64 ml/min/1.73 m2 but reduced significantly from 2.03 ± 5.82 to - 3.99 ± 5.78 ml/min/1.73 m2 from youngest to oldest age tertiles (P < 0.001). There was a significant difference in primary kidney disease (PKD) (77% versus 59%, with CAKUT, P = 0.048) but no difference in AKI incidence (37% versus 31%, P = 0.85) between age tertiles. Multiple regression analysis identified age (β = - 0.53, P < 0.001) and AKI (β = - 3.2, P = 0.001) as independent predictors of ΔGFR/year. 48.7% versus 22.1% with and without AKI reached composite end-point (P = 0.01). CONCLUSIONS We report AKI in established CKD as a predictor of accelerated kidney disease progression and highlight this as an additional modifiable risk factor to reduce progression of kidney dysfunction. Graphical abstract.
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Affiliation(s)
- Nabil Melhem
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & ST Thomas' Foundation Hospitals NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Pernille Rasmussen
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & ST Thomas' Foundation Hospitals NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Triona Joyce
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & ST Thomas' Foundation Hospitals NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Joanna Clothier
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & ST Thomas' Foundation Hospitals NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Christopher J D Reid
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & ST Thomas' Foundation Hospitals NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Caroline Booth
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & ST Thomas' Foundation Hospitals NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & ST Thomas' Foundation Hospitals NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Kings College London, London, UK
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20
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A rare case of tubulointerstitial nephritis and uveitis (TINU) syndrome: Answers. Pediatr Nephrol 2020; 35:2269-2274. [PMID: 32440946 DOI: 10.1007/s00467-020-04590-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
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21
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Naunova-Timovska S, Cekovska S, Sahpazova E, Tasić V. NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN AS AN EARLY BIOMARKER OF ACUTE KIDNEY INJURY IN NEWBORNS. Acta Clin Croat 2020; 59:55-62. [PMID: 32724275 PMCID: PMC7382871 DOI: 10.20471/acc.2020.59.01.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The aim of the study was to determine the incidence, risk factors and efficiency of the neutrophil gelatinase-associated lipocalin (NGAL) biomarker in early diagnosis of acute kidney injury (AKI) in newborns. The study was designed as a prospective, clinical, epidemiological investigation conducted in the period of three years, which included 50 newborns with AKI hospitalized in the Neonatal Intensive Care Unit, University Children’s Hospital in Skopje. The estimated prevalence of AKI was 6.4%, while the prevalence according to RIFLE classification was 8.7%. Perinatal asphyxia was a common predisposing factor associated to kidney injury. The mortality rate was 32% and was significantly higher in the group of newborns with congenital heart diseases. There was a significant difference between NGAL values and creatinine values on the day of admission. There was a significant difference in NGAL values between newborns with AKI and lethal outcome and newborns without lethal outcome (p<0.001). In conclusion, AKI is a life-threatening condition. It is an independent contributor to mortality. Urinary NGAL is an early predictive biomarker of AKI in critically ill newborns.
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Affiliation(s)
| | - Svetlana Cekovska
- 1University Children's Hospital, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia; 2Institute of Medical and Experimental Biochemistry, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Emilija Sahpazova
- 1University Children's Hospital, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia; 2Institute of Medical and Experimental Biochemistry, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Velibor Tasić
- 1University Children's Hospital, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia; 2Institute of Medical and Experimental Biochemistry, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
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22
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Parikh RV, Tan TC, Salyer AS, Auron A, Kim PS, Ku E, Go AS. Community-Based Epidemiology of Hospitalized Acute Kidney Injury. Pediatrics 2020; 146:peds.2019-2821. [PMID: 32784225 PMCID: PMC7461200 DOI: 10.1542/peds.2019-2821] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) may lead to short- and long-term consequences in children, but its epidemiology has not been well described at a population level and outside of ICU settings. METHODS In a large, diverse pediatric population receiving care within an integrated health care delivery system between 2008 and 2016, we calculated age- and sex-adjusted incidences of hospitalized AKI using consensus serum creatinine (SCr)-based diagnostic criteria. We also investigated the proportion of AKI detected in non-ICU settings and the rates of follow-up outpatient SCr testing after AKI hospitalization. RESULTS Among 1 500 546 children, the mean age was 9.8 years, 49.0% were female, and 33.1% were minorities. Age- and sex-adjusted incidence of hospitalized AKI among the entire pediatric population did not change significantly across the study period, averaging 0.70 (95% confidence interval: 0.68-0.73) cases per 1000 person-years. Among the subset of hospitalized children, the adjusted incidence of AKI increased from 6.0% of hospitalizations in 2008 to 8.8% in 2016. Approximately 66.7% of AKI episodes were not associated with an ICU stay, and 54.3% of confirmed, unresolved Stage 2 or 3 AKI episodes did not have outpatient follow-up SCr testing within 30 days postdischarge. CONCLUSIONS Community-based pediatric AKI incidence was ∼1 per 1000 per year, with two-thirds of cases not associated with an ICU stay and more than one-half not receiving early outpatient follow-up kidney function testing. Further efforts are needed to increase the systematic recognition of AKI in all inpatient settings with appropriate, targeted postdischarge kidney function monitoring and associated management.
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Affiliation(s)
- Rishi V. Parikh
- Division of Research, Kaiser Permanente Northern
California, Oakland, California
| | - Thida C. Tan
- Division of Research, Kaiser Permanente Northern
California, Oakland, California
| | - Anne S. Salyer
- Department of Pediatric Nephrology, Oakland Medical
Center, Kaiser Permanente, Oakland, California
| | - Ari Auron
- Department of Pediatric Nephrology, Roseville Medical
Center, Kaiser Permanente, Roseville, California
| | - Peter S. Kim
- Department of Pediatric Nephrology, Santa Clara
Medical Center, Kaiser Permanente, Santa Clara, California
| | - Elaine Ku
- Divisions of Nephrology and Pediatric Nephrology,
Departments of Medicine and Pediatrics, University of California San Francisco,
San Francisco, California
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern
California, Oakland, California;,Departments of Epidemiology and Biostatistics and
Medicine, School of Medicine, University of California, San Francisco, San
Francisco, California; and,Division of Nephrology, Department of Medicine and
Department of Health Research and Policy, Stanford Medicine, Stanford
University, Palo Alto, California
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23
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Li D, Niu Z, Huang Q, Sheng W, Wang T. A meta-analysis of the incidence rate of postoperative acute kidney injury in patients with congenital heart disease. BMC Nephrol 2020; 21:350. [PMID: 32807107 PMCID: PMC7433101 DOI: 10.1186/s12882-020-02005-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/03/2020] [Indexed: 01/07/2023] Open
Abstract
Background Acute kidney injury (AKI) is a common complication of cardiac surgery. However, the incidence rate of AKI in patients with congenital heart disease (CHD) greatly varies between reports owing to the different definitions used for AKI. Therefore, this study was designed as a meta-analysis aimed at summarizing the incidence rate of AKI in patients with congenital heart disease (CHD) on the basis of different AKI criteria. Methods Studies published till April 24, 2020, on the incidence rate of AKI in patients with CHD, were retrieved from electronic databases and printed literature. To pool data from the included studies, the effect size, a combined statistics, was chosen and presented with the incidence rate and 95% confidence interval (CI). Heterogeneity was evaluated using I2 statistics and Cochran Q test. The incidence rates obtained from the subgroup analysis according to study location, type of surgery, type of cohort, age, and AKI criteria) were also evaluated to determine the correlation of AKI with these factors. Publication bias was estimated using the Egger test. Results Thirty studies, comprising 9925 patients with AKI who had CHD, were included. Overall, the pooled incidence rate of AKI in the patients with CHD was 38.4% (95% CI, 32.0–44.7%). However, the incidence rate was not significantly affected by gender, study location, type of surgery, type of cohort, and AKI criteria. Moreover, age was significantly associated with the incidence of AKI, and the incidence rate was higher in the patients aged < 1 month than in those aged 1 month to 18 years, < 18 years, and ≥ 18 years (P < 0.05). Conclusions In this study, the estimated incidence rate of AKI in patients with CHD was 38.4% and may be influenced by age. These findings highlight the importance of further investigation of the specific causes of and effective preventive measures for AKI.
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Affiliation(s)
- Dandan Li
- Department of Environmental Health, Qingdao Centers for Disease Control and Prevention, Qingdao, 266033, Shandong, China
| | - Zhaozhuo Niu
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, No. 5 Donghai Middle Road, Shinan District, Qingdao, 266000, Shandong, China
| | - Qiang Huang
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, No. 5 Donghai Middle Road, Shinan District, Qingdao, 266000, Shandong, China
| | - Wei Sheng
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, No. 5 Donghai Middle Road, Shinan District, Qingdao, 266000, Shandong, China
| | - Tianyi Wang
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, No. 5 Donghai Middle Road, Shinan District, Qingdao, 266000, Shandong, China.
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Dolan E, Hellinga R, London M, Ryan K, Dehority W. Effect of Vancomycin Loading Doses on the Attainment of Target Trough Concentrations in Hospitalized Children. J Pediatr Pharmacol Ther 2020; 25:423-430. [PMID: 32641912 DOI: 10.5863/1551-6776-25.5.423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Subtherapeutic vancomycin trough concentrations are common in children and may be associated with suboptimal therapeutic response. Our objective was to determine if vancomycin loading doses safely increase the frequency of target trough attainment in hospitalized children. METHODS Patients (≥6 months and <18-years-old) who received a vancomycin loading dose between February 1, 2018, and January 30, 2019, were retrospectively enrolled. These patients were compared to a convenience cohort of patients hospitalized between January 1, 2015, and December 31, 2015, who received vancomycin without a loading dose. Target trough concentrations were defined as >15 mg/dL for invasive infections and >10 mg/dL for non-invasive infections. RESULTS A total of 151 patients were enrolled, with 77 in the control arm and 74 in the loading dose arm. There was no significant difference in the frequency of comorbidities or need for intensive care unit admission between the two arms. Those receiving a vancomycin loading dose were older (mean age 9.1 vs 5.2 years, p < 0.0001). Patients given a loading dose achieved higher mean initial trough values (13.0 mg/dL vs 9.2 mg/dL, p < 0.0001), were more likely to have an initial trough at or above target (37.0% vs 10.4%, p = 0.0001), were more likely to reach target trough values at any point during therapy (52.1% vs 32.9%, p = 0.0081), and attained a target trough concentration more quickly (mean 41.1 hours vs 58.8 hours, p = 0.0118). There were no significant differences in the frequency of serum creatinine elevation or oliguria at the end of therapy. CONCLUSIONS Vancomycin loading doses may improve the ability to safely obtain target trough values in hospitalized children.
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Abstract
Armed conflicts continue to occur in some regions of the globe, mostly in developing countries. These man-made disasters affect all segments of the population; however, some groups are more vulnerable and suffer more seriously from the unfavorable consequences of such conflicts. Among these, the pediatric population deserves special attention because they cannot protect themselves, and hence carry a higher threat of injuries and probability of death during conflicts. In addition, children who do survive the disaster are more prone to exploitation. Pediatric victims, including those who sustain acute kidney injury or those suffering from chronic kidney disease before armed conflicts, face higher risks of morbidity and mortality as a result of treatment problems, specifically limited dialysis options. Displaced children, forced to flee their homes as a result of armed conflicts, are also at risk for various health problems because they may not find ideal circumstances for disease treatment. Making preparations in anticipation of armed conflicts, such as disaster-relief scenarios and action plans, may be useful to decrease the death toll in these children, who are dependent on their caregivers for survival. Adopting principles of disaster nephrology may contribute to improved survival chances of pediatric kidney patients in chaotic circumstances.
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26
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Memon MKY, Akhtar S, Martins RS, Ahmed R, Saeed A, Shaheen F. Adult congenital heart disease: frequency, risk factors and outcomes of acute kidney injury in postoperative period. Indian J Thorac Cardiovasc Surg 2020; 36:365-372. [PMID: 33061144 DOI: 10.1007/s12055-020-00926-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/01/2020] [Accepted: 01/07/2020] [Indexed: 01/11/2023] Open
Abstract
Background Acute kidney injury (AKI) after surgery for congenital heart disease (CHD) in adults is poorly studied despite being well-recognized as a postoperative complication after cardiac surgery in adults. The primary aim of our study was to determine the frequency of AKI in adults undergoing surgery for CHD. We also aimed to determine risk factors and predictors of AKI in this patient population, and to explore outcomes in terms of duration of mechanical ventilation, intensive care unit (ICU) stay, and hospital stay. Methods This retrospective cross-sectional study included all adult patients (18 years) who underwent cardiac surgery with cardiopulmonary bypass for their congenital heart problems from January 2011 to December 2016 in a tertiary-care private hospital. Results A total of 166 patients with a mean age of 32.05 ± 12.11 years were included in this study. The postoperative course was complicated by AKI in 29.5% of patients. Thirty-two percent of these patients had moderate-to-severe kidney disease. Two patients (4%) developing AKI required renal replacement therapy in the form of transient hemodialysis. All patients in our study showed complete resolution of AKI, with no mortalities in the postoperative period. On univariable analysis, (Risk adjusted classification for congenital heart surgery-1) RACHS-1 category 2 and 3, aortic valve replacement, preoperative creatinine clearance, ventricular septal defect closure, cardiopulmonary bypass time, aortic cross-clamp time, intra-operative excessive blood loss, intra-operative ionotropic score, and postoperative hypotension were found to be significant predictors for the development of AKI. On age-adjusted multivariable analysis, RACHS-1 category 2 (OR = 3.49; CI = 1.22-9.95) and category 3 (OR = 3.28 = 1.15-9.36), and intra-operative excessive blood loss (OR = 2.9; CI = 1.07-7.85) were significant predictors of AKI development in the postoperative period. Moreover, development of AKI postoperatively was a predictor of a significantly longer cardiac intensive care unit (CICU) stay (OR = 1.21; CI = 1.08-1.37). Conclusion We found that preoperative creatinine clearance, ACC time, intraoperative excessive blood loss, and RACHS-1Category 2 and 3 are potential risk factors for postoperative AKI development. Moreover, patients who develop AKI are likely to have a significantly longer CICU stay. Our study has tried to fill the lacunae with regard to AKI in adults undergoing surgery for CHD. However, there is a need for more studies with larger cohorts involving more complex surgeries to truly estimate the incidence and potential risk factors for AKI in this group of patients.
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Affiliation(s)
| | | | | | | | - Amjad Saeed
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Fariha Shaheen
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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27
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Bhojani S, Stojanovic J, Melhem N, Maxwell H, Houtman P, Hall A, Singh C, Hayes W, Lennon R, Sinha MD, Milford DV. The Incidence of Paediatric Acute Kidney Injury Identified Using an AKI E-Alert Algorithm in Six English Hospitals. Front Pediatr 2020; 8:29. [PMID: 32117834 PMCID: PMC7026188 DOI: 10.3389/fped.2020.00029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 01/20/2020] [Indexed: 11/25/2022] Open
Abstract
Objective: Acute kidney injury (AKI) is a significant cause of morbidity and mortality among hospitalised patients. The objectives in this study were (i) to investigate the incidence of AKI using the National Health Services (NHS) AKI e-alert algorithm as a means of identifying AKI; and (ii) in a randomly selected sub-group of children with AKI identified using the algorithm, to evaluate the recognition and management of AKI. Patients and Methods: Retrospective cross-sectional study with initial electronic retrieval of creatinine measurements at six hospitals in England over a six-month period. Results were evaluated using the NHS AKI e-alert algorithm with recognition and management of AKI stages 1, 2 and 3 reviewed in a sub-set of randomly selected patient case notes. Patients aged 29 to 17 years were included. AKI stage 1 was defined as a rise of 1.5 - ≤2x baseline creatinine level; AKI stage 2 a rise of ≤ 2.0 and < 3.0; AKI stage 3 a rise of ≥ 3.0. Urine output was not considered for AKI staging. Results: 57,278 creatinine measurements were analysed. 5,325 (10.8%) AKI alerts were noted in 1,112 patients with AKI 1 (62%), AKI 2 (16%) and AKI 3 (22%). There were 222 (20%) <1y, 432 (39%) 1 ≤ 6y, 192 (17%) 6 ≤ 11y, 207 (19%) 11 ≤ 16y, and 59 (5%) 16-17y. Case notes of 123 of 1,112 [11.1%] children with AKI alerts were reviewed. Confirmed AKI was recognised with a documented management plan following its identification in n = 32 [26%] patients only. Conclusions: In this first multicentre study of the incidence of AKI in children admitted to selected hospitals across England, the incidence of AKI was 10.8% with most patients under the age of 6 years and with AKI stage 1. Recognition and management of AKI was seen in just over 25% children. These data highlight the need to improve recognition of AKI in hospitalised children in the UK.
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Affiliation(s)
| | | | - Nabil Melhem
- Evelina London Children's Hospital, London, United Kingdom
| | | | - Peter Houtman
- Leicester Royal Infirmary, Leicester, United Kingdom
| | - Angela Hall
- Leicester Royal Infirmary, Leicester, United Kingdom
| | - Cheentan Singh
- North Middlesex University Hospital NHS Trust, London, United Kingdom
| | - Wesley Hayes
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Rachel Lennon
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Manish D Sinha
- Evelina London Children's Hospital, London, United Kingdom.,Kings College London, London, United Kingdom
| | - David V Milford
- Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
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Kalligeros M, Karageorgos SA, Shehadeh F, Zacharioudakis IM, Mylonakis E. The association of acute kidney injury with the concomitant use of vancomycin and piperacillin/tazobactam in children: A systematic review and meta-analysis. Antimicrob Agents Chemother 2019; 63:AAC.01572-19. [PMID: 31591125 PMCID: PMC6879222 DOI: 10.1128/aac.01572-19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/27/2019] [Indexed: 12/23/2022] Open
Abstract
Concomitant use of vancomycin plus piperacillin/tazobactam (TZP) has been associated with increased risk of acute kidney injury (AKI) in hospitalized adults. In this systematic review and meta-analysis, we searched PubMed and EMBASE for pediatric studies examining this hypothesis, with reference to vancomycin monotherapy or in combination with another beta-lactam antibiotic. Out of 1381 non-duplicate studies, 10 met our inclusion criteria. We performed a random effects meta-analysis, based on crude odds ratios, and we accounted for both quality of included studies and publication bias. In primary analysis, concomitant vancomycin and TZP use yielded a statistically significant association with the development of AKI. More specifically, children with AKI had higher odds to have been exposed to vancomycin plus TZP, in comparison with vancomycin monotherapy (OR 8.15; 95% CI: 3.49-18.99), or vancomycin plus any other beta-lactam antibiotic (OR 3.48; 95% CI: 2.71-4.46). Based on the results of the Newcastle Ottawa Scale quality assessment, a secondary analysis including only higher quality studies (6 out of 10 studies) yielded again higher odds of exposure to vancomycin plus TZP, compared to vancomycin plus another beta-lactam antibiotic (OR 3.76; 95% CI: 2.56-5.51). Notably, even after controlling for possible publication bias our results remained statistically significant (OR 3.09; 95% CI: 2.30-4.14). In conclusion, the concomitant use of vancomycin and TZP could be associated with AKI development and the clinical significance of this potential association needs to be studied further in the pediatric population.
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Affiliation(s)
- Markos Kalligeros
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI
| | - Spyridon A Karageorgos
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Fadi Shehadeh
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI
| | - Ioannis M Zacharioudakis
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI
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Herzog AL, Lopau K. Interstitielle Nephritis. Internist (Berl) 2019; 60:821-839. [DOI: 10.1007/s00108-019-0634-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Guzzo I, de Galasso L, Mir S, Bulut IK, Jankauskiene A, Burokiene V, Cvetkovic M, Kostic M, Bayazit AK, Yildizdas D, Schmitt CP, Paglialonga F, Montini G, Yilmaz E, Oh J, Weber L, Taylan C, Hayes W, Shroff R, Vidal E, Murer L, Mencarelli F, Pasini A, Teixeira A, Afonso AC, Drozdz D, Schaefer F, Picca S. Acute dialysis in children: results of a European survey. J Nephrol 2019; 32:445-451. [PMID: 30949986 DOI: 10.1007/s40620-019-00606-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 03/28/2019] [Indexed: 12/21/2022]
Abstract
The number of children with acute kidney injury (AKI) requiring dialysis is increasing. To date, systematic analysis has been largely limited to critically ill children treated with continuous renal replacement therapy (CRRT). We conducted a survey among 35 European Pediatric Nephrology Centers to investigate dialysis practices in European children with AKI. Altogether, the centers perform dialysis in more than 900 pediatric patients with AKI per year. PD and CRRT are the most frequently used dialysis modalities, accounting for 39.4% and 38.2% of treatments, followed by intermittent HD (22.4%). In units treating more than 25 cases per year and in those with cardiothoracic surgery programs, PD is the most commonly chosen dialysis modality. Also, nearly one quarter of centers, in countries with a gross domestic product below $35,000/year, do not utilize CRRT at all. Dialysis nurses are exclusively in charge of CRRT management in 45% of the cases and pediatric intensive care nurses in 25%, while shared management is practiced in 30%. In conclusion, this survey indicates that the choice of treatment modalities for dialysis in children with AKI in Europe is affected by the underlying ethiology of the disease, organization/set-up of centers and socioeconomic conditions. PD is utilized as often as CRRT, and also intermittent HD is a commonly applied treatment option. A prospective European AKI registry is planned to provide further insights on the epidemiology, management and outcomes of dialysis in pediatric AKI.
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Affiliation(s)
- Isabella Guzzo
- Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Institute for Scientific Research, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Lara de Galasso
- Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Institute for Scientific Research, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Sevgi Mir
- Ege University Faculty of Medicine, Izmir, Turkey
| | | | - Augustina Jankauskiene
- Clinic of Children Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Vilmanta Burokiene
- Children Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | - Aysun Karabay Bayazit
- Department of Pediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Dincer Yildizdas
- Department of Pediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Claus Peter Schmitt
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Fabio Paglialonga
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Jun Oh
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Weber
- Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
| | - Christina Taylan
- Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
| | - Wesley Hayes
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Rukshana Shroff
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Enrico Vidal
- Azienda Ospedaliera-University of Padua, Padua, Italy
| | - Luisa Murer
- Azienda Ospedaliera-University of Padua, Padua, Italy
| | | | | | - Ana Teixeira
- Centro Materno-Infantil do Norte, Porto, Portugal
| | | | - Dorota Drozdz
- Jagiellonian University Medical College, Krakow, Poland
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Stefano Picca
- Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Institute for Scientific Research, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy
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VanSickle JS, Srivastava T, Alon US. Risk Factors for Short- and Long-Term Outcomes in Children With STEC-HUS/D + HUS: A Single-Center Experience. Glob Pediatr Health 2018; 5:2333794X18816920. [PMID: 30547058 PMCID: PMC6287298 DOI: 10.1177/2333794x18816920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 11/17/2022] Open
Abstract
Background. Hemolytic uremic syndrome (HUS) is one of the common causes for acute kidney injury in childhood. Objective. The goals of our study were to identify risk factors for short-term complications and long-term outcomes of chronic kidney disease (CKD) in Shiga toxin-producing Escherichia coli (STEC)-HUS and other diarrhea positive (D+) HUS. Methods. Retrospective chart review was obtained of 58 pediatric patients treated for STEC-HUS and other D+ HUS between February 2002 and January 2011. Results. Thirty-three patients (56.9%) required dialysis. Dialysis was more likely initiated if a patient was a female (P < .012), oliguric (urine output < 0.5 mL/kg/h, P < .0005), or hemoglobin (HGB) level >10 g/dL (P = .009) at admission. Neurological complications developed only among 5 dialyzed patients (P < .042), and were more common if the patient received hemodialysis (HD) compared with peritoneal dialysis (P < .0005). CKD was noted during the subsequent follow-up clinic visits in 5 patients (8.6%). Those who developed CKD received HD (P = .002), dialysis for >10 days (P = .0004), or HGB level >10 g/dL (P = .034) at admission. Conclusions. Children with STEC-HUS/D+ HUS who may need dialysis are identified by female gender, lower urine output, higher serum creatinine level, and higher HGB at admission. They are at higher risk developing central nervous system complications especially if they needed HD. Children requiring >10 days of dialysis are at risk for development of CKD.
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Affiliation(s)
- Judith Sebestyen VanSickle
- The Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,University of Missouri at Kansas City, MO, USA
| | - Tarak Srivastava
- The Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,University of Missouri at Kansas City, MO, USA
| | - Uri S Alon
- The Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,University of Missouri at Kansas City, MO, USA
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Lin Q, Mao JH. Early prediction of acute kidney injury in children: known biomarkers but novel combination. World J Pediatr 2018; 14:617-620. [PMID: 30112669 DOI: 10.1007/s12519-018-0180-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/01/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Qian Lin
- Department of Nephrology, Children's Hospital, Zhejiang University School of Medicine, No.57 Zhugan Lane, Hangzhou, 310003, China
| | - Jian-Hua Mao
- Department of Nephrology, Children's Hospital, Zhejiang University School of Medicine, No.57 Zhugan Lane, Hangzhou, 310003, China.
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33
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Cleto-Yamane TL, Gomes CLR, Suassuna JHR, Nogueira PK. Acute Kidney Injury Epidemiology in pediatrics. J Bras Nefrol 2018; 41:275-283. [PMID: 30465591 PMCID: PMC6699449 DOI: 10.1590/2175-8239-jbn-2018-0127] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/05/2018] [Indexed: 03/19/2023] Open
Abstract
We performed a search in the MEDLINE database using the MeSH term: "Acute Kidney
Injury", selecting the subtopic "Epidemiology", and applying age and year of
publication filters. We also searched for the terms: "acute renal failure" and
"epidemiology" "acute tubular necrosis" and "epidemiology" in the title and
summary fields with the same filters. In a second search, we searched in the
LILACS database, with the terms: "acute renal injury", or "acute renal failure"
or "acute kidney injury" and the age filter. All abstracts were evaluated by the
authors and the articles considered most relevant, were examined in their
entirety. Acute Kidney Injury (AKI) -related mortality ranged from 3-63% in the
studies included in this review. AKI etiology has marked regional differences,
with sepsis being the main cause in developed countries. In developing
countries, primary renal diseases and hypovolemia are still a common cause of
AKI.
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34
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Ao X, Zhong Y, Yu XH, Marshall MR, Feng T, Ning JP, Zhou QL. Acute Peritoneal Dialysis System for Neonates with Acute Kidney Injury Requiring Renal Replacement Therapy: A Case Series. Perit Dial Int 2018; 38:S45-S52. [PMID: 30315044 DOI: 10.3747/pdi.2018.00109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/23/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common in critically ill neonates, and peritoneal dialysis (PD) can be a lifesaving option. In China, however, much of the equipment for PD in neonates is not available. We describe results with a novel system for PD, which has been developed locally to improve access to therapy and care for critically ill neonates requiring PD in China. METHODS The system comprises a 14-gauge single-lumen central venous catheter serving as a PD catheter, inserted by Seldinger technique, with an adapted twin bag PD system. Ten neonates with AKI were treated using the novel PD system. RESULTS The 10 patients ranged in age from 1 day to 22 days, with bodyweights between 700 g and 3,300 g. Average time to renal function recovery was between 14 and 96 hours. Complications related to the novel PD system included leak (n = 1), catheter displacement (n = 1), and catheter obstruction (n = 1). There were no complications related to insertion, no cases of peritonitis or exit-site infection, and no subsequent hernias. A comparison of costs indicated that the novel PD system is less expensive than conventional systems involving open insertion of Tenckhoff catheters. CONCLUSIONS Peritoneal dialysis using the novel PD system is simple, safe, and effective for suitable neonates with AKI in China.
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Affiliation(s)
- Xiang Ao
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yong Zhong
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiao-He Yu
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | | | - Tao Feng
- Medical Affairs, Baxter China, Shanghai, PR China
| | - Jian-Ping Ning
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiao-Ling Zhou
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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35
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Gaudreault-Tremblay MM, Litalien C, Patey N, Merouani A. Severe Acute Kidney Injury and Multiple Organ Failure in a 17-Day-Old Newborn: When Pathology Makes the Difference. Can J Kidney Health Dis 2018; 5:2054358118804834. [PMID: 30305914 PMCID: PMC6174648 DOI: 10.1177/2054358118804834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/22/2018] [Indexed: 12/24/2022] Open
Abstract
Rationale: Acute tubulointerstitial nephritis (ATIN) in children is most commonly due to allergic drug reactions. In neonates, diagnosis of ATIN is clinically suspected and a kidney biopsy is not routinely performed. Presenting concern: A 17-day-old newborn presented with vomiting and dehydration, along with anuric acute kidney injury, severe electrolyte disturbances, hypocomplementemia, and thrombocytopenia. Abdominal ultrasound revealed bilateral nephromegaly and hepatosplenomegaly. The patient was promptly started on intravenous (IV) fluid and broad-spectrum antibiotics. His electrolyte disturbances were corrected as per standard guidelines. The rapid progressive clinical deterioration despite maximal treatment and the unclear etiology influenced the decision to proceed to a kidney biopsy. Histopathological findings revealed diffuse interstitial edema with a massive polymorphic cellular infiltrate and destruction of tubular structures, consistent with severe ATIN. Elements of thrombotic microangiopathy (TMA) were observed. Diagnosis: The clinical presentation combined with imaging and histopathological findings was suggestive of ATIN caused by a severe acute bacterial pyelonephritis. Intervention: Methylprednisolone pulses followed by oral prednisolone were administered. Antibiotics were continued for 10 days. The patient was kept on invasive mechanical ventilation and on peritoneal dialysis for 12 days. Outcome: His condition stabilized following steroid pulses. His renal function progressively improved, and renal replacement therapy was weaned off. His renal ultrasound normalized. He has maintained a normal blood pressure, urinalysis, and renal function over the past 5 years. Novel finding: This case reports a severe presentation of acute bacterial pyelonephritis in a neonate. It highlighted the involvement of complement activation in severe infectious process. Histopathological findings of ATIN and TMA played a crucial role in understanding the physiopathology and severity of the disease.
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Affiliation(s)
- Marie-Michèle Gaudreault-Tremblay
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Nephrology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, QC, Canada
| | - Catherine Litalien
- Division of Critical Care Medicine and General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, QC, Canada
| | - Natalie Patey
- Department of Pathology, CHU Sainte-Justine, Université de Montréal, QC, Canada
| | - Aicha Merouani
- Division of Nephrology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, QC, Canada
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36
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Prognosis and Early Prediction of Acute Kidney Injury in Critically Ill Children. Nephrourol Mon 2018. [DOI: 10.5812/numonthly.83423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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37
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Evolution of Acute Kidney Injury and Its Association With Systemic Hemodynamics in Children With Fluid-Refractory Septic Shock. Crit Care Med 2018; 46:e677-e683. [DOI: 10.1097/ccm.0000000000003156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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38
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Kao AY, Sagar P, Klig JE, Sharma A, Tomaszewski KJ. Case 19-2018: A 15-Year-Old Girl with Acute Kidney Injury. N Engl J Med 2018; 378:2421-2429. [PMID: 29924949 DOI: 10.1056/nejmcpc1802827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ann Y Kao
- From the Departments of Pediatrics (A.Y.K., A.S.), Medicine (A.Y.K.), Radiology (P.S.), Emergency Medicine (J.E.K.), and Pathology (K.J.T.), Massachusetts General Hospital, and the Departments of Pediatrics (A.Y.K., A.S.), Medicine (A.Y.K.), Radiology (P.S.), Emergency Medicine (J.E.K.), and Pathology (K.J.T.), Harvard Medical School - both in Boston
| | - Pallavi Sagar
- From the Departments of Pediatrics (A.Y.K., A.S.), Medicine (A.Y.K.), Radiology (P.S.), Emergency Medicine (J.E.K.), and Pathology (K.J.T.), Massachusetts General Hospital, and the Departments of Pediatrics (A.Y.K., A.S.), Medicine (A.Y.K.), Radiology (P.S.), Emergency Medicine (J.E.K.), and Pathology (K.J.T.), Harvard Medical School - both in Boston
| | - Jean E Klig
- From the Departments of Pediatrics (A.Y.K., A.S.), Medicine (A.Y.K.), Radiology (P.S.), Emergency Medicine (J.E.K.), and Pathology (K.J.T.), Massachusetts General Hospital, and the Departments of Pediatrics (A.Y.K., A.S.), Medicine (A.Y.K.), Radiology (P.S.), Emergency Medicine (J.E.K.), and Pathology (K.J.T.), Harvard Medical School - both in Boston
| | - Amita Sharma
- From the Departments of Pediatrics (A.Y.K., A.S.), Medicine (A.Y.K.), Radiology (P.S.), Emergency Medicine (J.E.K.), and Pathology (K.J.T.), Massachusetts General Hospital, and the Departments of Pediatrics (A.Y.K., A.S.), Medicine (A.Y.K.), Radiology (P.S.), Emergency Medicine (J.E.K.), and Pathology (K.J.T.), Harvard Medical School - both in Boston
| | - Kristen J Tomaszewski
- From the Departments of Pediatrics (A.Y.K., A.S.), Medicine (A.Y.K.), Radiology (P.S.), Emergency Medicine (J.E.K.), and Pathology (K.J.T.), Massachusetts General Hospital, and the Departments of Pediatrics (A.Y.K., A.S.), Medicine (A.Y.K.), Radiology (P.S.), Emergency Medicine (J.E.K.), and Pathology (K.J.T.), Harvard Medical School - both in Boston
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Criss CN, Selewski DT, Sunkara B, Gish JS, Hsieh L, Mcleod JS, Robertson JO, Matusko N, Gadepalli SK. Acute kidney injury in necrotizing enterocolitis predicts mortality. Pediatr Nephrol 2018; 33:503-510. [PMID: 28983789 DOI: 10.1007/s00467-017-3809-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/01/2017] [Accepted: 09/08/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Morbidity and mortality with necrotizing enterocolitis (NEC) remains a significant challenge. Acute kidney injury (AKI) has been shown to worsen survival in critically ill neonates. To our knowledge, this study is the first to evaluate the prevalence of AKI and its impact on outcomes in neonatal NEC. METHODS We carried out a single-center retrospective chart review of all neonates treated for NEC between 2003 and 2015 (N = 181). AKI is defined as a rise in serum creatinine (SCr) from a previous trough according to neonatal modified KDIGO criteria (stage 1 = SCr rise 0.3 mg/dL or SCr 150 < 200%, stage 2 = SCr rise 200 < 300%, stage 3 = SCr rise ≥300%, SCr 2.5 mg/dL or dialysis). Primary outcome was in-hospital mortality and secondary outcomes were hospital length of stay (LOS) and need for and type of surgery. RESULTS Acute kidney injury occurred in 98 neonates (54%), with 39 stage 1 (22%), 31 stage 2 (18%), and 28 stage 3 (16%), including 5 requiring dialysis. Non-AKI and AKI groups were not statistically different in age, weight, Bell's NEC criteria, and medication exposure (vasopressors, vancomycin, gentamicin, or diuretic). Neonates with AKI had higher mortality (44% vs 25.6%, p = 0.008) and a higher chance of death (HR 2.4, CI 1.2-4.8, p = 0.009), but the effect on LOS on survivors did not reach statistical significance (79 days, interquartile range [IQR] 30-104 vs 54 days, IQR 30-92, p = 0.09). Overall, 48 (27.9%) patients required surgical intervention. CONCLUSIONS This study shows that AKI not only occurs in over half of patients with NEC, but that it is also associated with more than a two-fold higher mortality, highlighting the importance of early recognition and potentially early intervention for AKI.
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Affiliation(s)
- Cory N Criss
- Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - David T Selewski
- Department of Pediatrics & Communicable Disease, Division of Pediatric Nephrology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
| | - Bipin Sunkara
- Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Joshua S Gish
- Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Lily Hsieh
- Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer S Mcleod
- Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Jason O Robertson
- Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Niki Matusko
- Department of General Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Samir K Gadepalli
- Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
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Piggott KD, Liu A, Monczka J, Fakioglu H, Narasimhulu SS, Pourmoghadam K, DeCampli W. Inadequate preoperative nutrition might be associated with acute kidney injury and greater illness severity postoperatively. J Thorac Cardiovasc Surg 2017; 155:2104-2109. [PMID: 29366566 DOI: 10.1016/j.jtcvs.2017.12.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 12/10/2017] [Accepted: 12/16/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Nutrition is vital for maintaining optimal cellular and organ function, particularly in neonates who undergo cardiac surgery. Achieving nutritional goals preoperatively can be challenging because of fluid restrictions, suboptimal oral intake, and concerns for inadequate gastrointestinal circulation. We examined preoperative caloric intake and its effects on postoperative course in neonates who underwent cardiac surgery. METHODS We retrospectively reviewed records of neonates (younger than 30 days) who underwent congenital heart surgery requiring cardiopulmonary bypass from 2008 to 2014 at Arnold Palmer Hospital for Children. Data on multiple nutritional and postoperative variables were collected. Study outcomes included hospital length of stay, duration of mechanical ventilation, and acute kidney injury (AKI). RESULTS Records of 95 neonates were reviewed. Sixty-six patients (69.5%) with a median age of 5 days did not achieve preoperative caloric goal, whereas 29 patients (30.5%) with a median age of 11 days did. Of those who achieved caloric goal, 6 (20.6%) achieved it via total parental nutrition, 9 (31.1%) with a combination of total parental nutrition and enteral feeds, and 14 (48.3%) via enteral route. There was a significant difference in peak lactate (P = .002), inotropic score (P = .02), and duration of mechanical ventilation (P = .013) between those who did and did not achieve caloric goal. In multivariable analysis we found that failure to achieve caloric goal preoperatively was independently associated with stage 2 or 3 AKI (P = .04; odds ratio, 4.48; 95% confidence interval, 1.02-19.63) and younger age at the time of surgery (P < .001; odds ratio, 0.12; 95% confidence interval, 0.04-0.33). CONCLUSIONS Failure to achieve preoperative caloric goal might contribute to development of AKI and might be associated with greater severity of illness postoperatively.
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Affiliation(s)
- Kurt D Piggott
- Pediatric Cardiac Intensive Care, Arnold Palmer Hospital for Children, Orlando, Fla; University of Central Florida College of Medicine, Orlando, Fla.
| | - Anne Liu
- University of Central Florida College of Medicine, Orlando, Fla
| | - Jessica Monczka
- Pediatric Cardiac Nutrition, Arnold Palmer Hospital for Children, Orlando, Fla
| | - Harun Fakioglu
- Pediatric Cardiac Intensive Care, Arnold Palmer Hospital for Children, Orlando, Fla; University of Central Florida College of Medicine, Orlando, Fla
| | - Sukumar Suguna Narasimhulu
- Pediatric Cardiac Intensive Care, Arnold Palmer Hospital for Children, Orlando, Fla; University of Central Florida College of Medicine, Orlando, Fla
| | - Kamal Pourmoghadam
- University of Central Florida College of Medicine, Orlando, Fla; Pediatric Cardiothoracic Surgery, Arnold Palmer Hospital for Children, Orlando, Fla
| | - William DeCampli
- University of Central Florida College of Medicine, Orlando, Fla; Pediatric Cardiothoracic Surgery, Arnold Palmer Hospital for Children, Orlando, Fla
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41
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Soni H, Adebiyi A. Early septic insult in neonatal pigs increases serum and urinary soluble Fas ligand and decreases kidney function without inducing significant renal apoptosis. Ren Fail 2017; 39:83-91. [PMID: 27767365 PMCID: PMC6014332 DOI: 10.1080/0886022x.2016.1244082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/06/2016] [Indexed: 01/20/2023] Open
Abstract
Apoptosis of renal tubular and glomerular cells during kidney disease involves activation of Fas ligand (FasL)-dependent death pathway. The significance of FasL in neonates with septic acute kidney injury (AKI) is unresolved, but an increase in renal FasL production, and/or infiltration of circulating FasL into the kidneys may occur following initial septic insult. Here, we examined whether soluble Fas ligand (sFasL) levels are altered during early phase of septic AKI in neonates. Six hours of polymicrobial sepsis elicited by cecal ligation and puncture (CLP) elevated serum C-reactive protein (CRP) (a bacteremia and sepsis marker) concentration in anesthetized and mechanically ventilated neonatal pigs. Serum creatinine and urea nitrogen concentrations were increased by ∼39% and 46%, respectively, following 6 h of CLP in the pigs. The urinary level of NGAL, an early marker of AKI was also elevated by ∼71% in the septic pigs. The basal concentration of sFasL in the serum and urine of neonatal pigs was similar. Six hours of CLP significantly increased serum and urine sFasL levels in the pigs by ∼24% and 68%, respectively. However, there was no evidence of caspase activation to suggest an induction of cellular apoptotic process in the kidneys of the septic pigs. These findings suggest that an increase in circulating and urinary sFasL during early septic AKI in neonatal pigs is not associated with renal apoptosis.
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Affiliation(s)
- Hitesh Soni
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adebowale Adebiyi
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Balestracci A, Toledo I, Meni Battaglia L, de Lillo L, More N, Cao G, Alvarado C. Postdiarrhoeal haemolytic uraemic syndrome without thrombocytopenia. Nefrologia 2017; 37:508-514. [PMID: 28946963 DOI: 10.1016/j.nefro.2016.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/01/2016] [Accepted: 12/10/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Thrombocytopenia is a hallmark of postdiarrhoeal haemolytic uraemic syndrome (D+ HUS), although it can be transient and therefore undetected. There is scarce information regarding the prevalence and the course of the disease in children with D+ HUS without thrombocytopenia. OBJECTIVE To determine the prevalence of D+ HUS without thrombocytopenia and to describe the clinical characteristics of a series of children with this condition. PATIENTS AND METHODS The medical records of patients with D+ HUS hospitalised between 2000 and 2016 were reviewed to identify those without thrombocytopenia (>150,000mm3). Demographic, clinical and laboratory parameters of the selected cases were collected and descriptively analysed. RESULTS Nine cases (5.6%) without thrombocytopenia were identified among 161 patients hospitalised during the study period. Median age at diagnosis was 17 months (7-32) and median prodromal symptom duration was 15 days (7-21). Eight patients maintained normal urine output while the remaining one required dialysis. No patient presented with severe extrarenal compromise and/or hypertension. CONCLUSIONS The prevalence of non-thrombocytopenic D+ HUS was 5.6% and most cases occurred with mild forms of the disease; however, the need for dialysis in one of them indicated that normalisation of platelet count is not always an accurate marker for disease remittance. Our results also confirm that the time of onset of D+ HUS in patients without thrombocytopenia is usually delayed with respect to the initial intestinal symptoms; thus, heightened diagnostic suspicion is necessary.
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Affiliation(s)
- Alejandro Balestracci
- Unidad de Nefrología, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Ismael Toledo
- Unidad de Nefrología, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina
| | - Luciana Meni Battaglia
- Unidad de Nefrología, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina
| | - Leonardo de Lillo
- Departamento de Pediatría, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina
| | - Natalia More
- Departamento de Pediatría, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriel Cao
- División de Patología, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina
| | - Caupolican Alvarado
- Unidad de Nefrología, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina
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Long-term health-related quality of life and psychological adjustment in children after haemolytic-uraemic syndrome. Pediatr Nephrol 2017; 32:869-878. [PMID: 28012007 DOI: 10.1007/s00467-016-3569-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND In children after haemolytic-uraemic syndrome (HUS), little is known about long-term health-related quality of life (HRQoL) and psychological adjustment as defined by behavioural problems, depressive symptoms and post-traumatic stress symptoms. METHODS Sixty-two paediatric patients with a history of HUS were included in this study. Medical data of the acute HUS episode were retrieved retrospectively from hospital records. Data on the clinical course at study investigation were assessed by clinical examination and laboratory evaluation. HRQoL and psychological adjustment data were measured by standardised, parent- and self-reported questionnaires. RESULTS Haemolytic-uraemic syndrome was diagnosed at a mean of 6.5 years before the initiation of the study (standard deviation 2.9, range 0.1-15.7) years. Among the preschool children, parents reported that their child was less lively and energetic (HRQoL emotional dimension), while no increased behavioural problems were reported. In the school-age children, self- and proxy-reported HRQoL was well within or even above the norms, while increased total behavioural problems were found. The school-age children reported no increased depression scores. Also none of the children met the criteria for full or partial HUS-associated posttraumatic stress disorder. CONCLUSIONS Healthcare providers should be particularly alert to behavioural problems in school-age children with a history of HUS and to lower HRQoL in preschool children.
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Genetic makeup of Shiga toxin-producing Escherichia coli in relation to clinical symptoms and duration of shedding: a microarray analysis of isolates from Swedish children. Eur J Clin Microbiol Infect Dis 2017; 36:1433-1441. [PMID: 28421309 PMCID: PMC5524872 DOI: 10.1007/s10096-017-2950-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/24/2017] [Indexed: 12/19/2022]
Abstract
Shiga toxin (Stx)-producing Escherichia coli (STECs) cause non-bloody diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome, and are the primary cause of acute renal failure in children worldwide. This study investigated the correlation of genetic makeup of STEC strains as revealed by DNA microarray to clinical symptoms and the duration of STEC shedding. All STEC isolated (n = 96) from patients <10 years of age in Jönköping County, Sweden from 2003 to 2015 were included. Isolates were characterized by DNA microarray, including almost 280 genes. Clinical data were collected through a questionnaire and by reviewing medical records. Of the 96 virulence genes (including stx) in the microarray, 62 genes were present in at least one isolate. Statistically significant differences in prevalence were observed for 21 genes when comparing patients with bloody diarrhea (BD) and with non-bloody stool (18 of 21 associated with BD). Most genes encode toxins (e.g., stx2 alleles, astA, toxB), adhesion factors (i.e. espB_O157, tir, eae), or secretion factors (e.g., espA, espF, espJ, etpD, nleA, nleB, nleC, tccP). Seven genes were associated with prolonged stx shedding; the presence of three genes (lpfA, senB, and stx1) and the absence of four genes (espB_O157, espF, astA, and intI1). We found STEC genes that might predict severe disease outcome already at diagnosis. This can be used to develop diagnostic tools for risk assessment of disease outcome. Furthermore, genes associated with the duration of stx shedding were detected, enabling a possible better prediction of length of STEC carriage after infection.
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Joyce E, Glasner P, Ranganathan S, Swiatecka-Urban A. Tubulointerstitial nephritis: diagnosis, treatment, and monitoring. Pediatr Nephrol 2017; 32:577-587. [PMID: 27155873 PMCID: PMC5099107 DOI: 10.1007/s00467-016-3394-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/15/2016] [Accepted: 04/04/2016] [Indexed: 12/15/2022]
Abstract
Tubulointerstitial nephritis (TIN) is a frequent cause of acute kidney injury (AKI) that can lead to chronic kidney disease (CKD). TIN is associated with an immune-mediated infiltration of the kidney interstitium by inflammatory cells, which may progress to fibrosis. Patients often present with nonspecific symptoms, which can lead to delayed diagnosis and treatment of the disease. Etiology can be drug-induced, infectious, idiopathic, genetic, or related to a systemic inflammatory condition such as tubulointerstitial nephritis and uveitis (TINU) syndrome, inflammatory bowel disease, or immunoglobulin G4 (IgG4)-associated immune complex multiorgan autoimmune disease (MAD). It is imperative to have a high clinical suspicion for TIN in order to remove potential offending agents and treat any associated systemic diseases. Treatment is ultimately dependent on underlying etiology. While there are no randomized controlled clinical trials to assess treatment choice and efficacy in TIN, corticosteroids have been a mainstay of therapy, and recent studies have suggested a possible role for mycophenolate mofetil. Urinary biomarkers such as alpha1- and beta2-microglobulin may help diagnose and monitor disease activity in TIN. Screening for TIN should be implemented in children with inflammatory bowel disease, uveitis, or IgG4-associated MAD.
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Affiliation(s)
- Emily Joyce
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.
| | - Paulina Glasner
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk and Department of Ophthalmology, Medical University of Gdansk, 80-299, Gdańsk, Poland
| | - Sarangarajan Ranganathan
- Department of Pediatric Pathology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Agnieszka Swiatecka-Urban
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224, USA
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Riyuzo MC, Silveira LVDA, Macedo CS, Fioretto JR. Predictive factors of mortality in pediatric patients with acute renal injury associated with sepsis. J Pediatr (Rio J) 2017; 93:28-34. [PMID: 27379973 DOI: 10.1016/j.jped.2016.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 03/21/2016] [Accepted: 04/08/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the prognosis factors of children with sepsis and acute kidney injury. METHODS This was a retrospective study of children with sepsis and acute kidney injury that were admitted to the pediatric intensive care unit (PICU) of a tertiary hospital. A multivariate analysis was performed to compare risk factors for mortality. RESULTS Seventy-seven children (47 males) were retrospectively studied, median age of 4 months. Mean length of hospital stay was 7.33±0.16 days, 68.9% of patients received mechanical ventilation, 25.9% had oligo-anuria, and peritoneal dialysis was performed in 42.8%. The pRIFLE criteria were: injury (5.2%) and failure (94.8%), and the staging system criteria were: stage 1 (14.3%), stage 2 (29.9%), and stage 3 (55.8%). The mortality rate was 33.7%. In the multivariate analysis, the risk factors for mortality were PICU length of stay (OR=0.615, SE=0.1377, 95% CI=0.469-0.805, p=0.0004); invasive mechanical ventilation (OR=14.599, SE=1.1178, 95% CI=1.673-133.7564, p=0.0155); need for dialysis (OR=9.714, SE=0.8088, 95% CI=1.990-47.410, p=0.0049), and hypoalbuminemia (OR=10.484, SE=1.1147, 95% CI=1.179-93.200, p=0.035). CONCLUSIONS The risk factors for mortality in children with acute kidney injury were associated with sepsis severity.
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Affiliation(s)
- Marcia C Riyuzo
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Pediatria, Botucatu, SP, Brazil.
| | - Liciana V de A Silveira
- Universidade Estadual Paulista (UNESP), Instituto de Biociências de Botucatu, Departamento de Bioestatística, Botucatu, SP, Brazil
| | - Célia S Macedo
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Pediatria, Botucatu, SP, Brazil
| | - José R Fioretto
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Pediatria, Botucatu, SP, Brazil
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Predictive factors of mortality in pediatric patients with acute renal injury associated with sepsis. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2017. [DOI: 10.1016/j.jpedp.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Acute Kidney Injury in Patients Undergoing the Extracardiac Fontan Operation With and Without the Use of Cardiopulmonary Bypass. Pediatr Crit Care Med 2017; 18:34-43. [PMID: 27792123 DOI: 10.1097/pcc.0000000000000984] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To describe the prevalence and risk factors for acute kidney injury in patients undergoing the extracardiac Fontan operation with and without cardiopulmonary bypass, and to determine whether acute kidney injury is associated with duration of mechanical ventilation, cardiovascular ICU and hospital postoperative length of stay, and early mortality. DESIGN Single-center retrospective cohort study. SETTING Pediatric cardiovascular ICU, university-affiliated children's hospital. PATIENTS Patients with a preoperative creatinine before undergoing first-time extracardiac Fontan between January 1, 2004, and April 30, 2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Acute kidney injury occurred in 55 of 138 patients (39.9%), including 41 (29.7%) with stage 1, six (4.4%) with stage 2, and eight (5.8%) with stage 3 acute kidney injury. Cardiopulmonary bypass was strongly associated with a higher risk of any acute kidney injury (adjusted odds ratio, 4.8 [95% CI, 1.4-16.0]; p = 0.01) but not stage 2/3 acute kidney injury. Lower renal perfusion pressure on the day of surgery (postoperative day, 0) was associated with a higher risk of stage 2/3 acute kidney injury (adjusted odds ratio, 1.2 [95% CI, 1.0-1.5]; p = 0.03). Higher vasoactive-inotropic score on postoperative day 0 was associated with a higher risk for stage 2/3 acute kidney injury (adjusted odds ratio, 1.9 [95% CI, 1.0-3.4]; p = 0.04). Stage 2/3 acute kidney injury was associated with longer cardiovascular ICU length of stay (mean, 7.3 greater d [95% CI, 3.4-11.3]; p < 0.001) and hospital postoperative length of stay (mean, 6.4 greater d [95% CI, 0.06-12.5]; p = 0.04). CONCLUSIONS Postoperative acute kidney injury in patients undergoing the extracardiac Fontan operation is common and is associated with lower postoperative renal perfusion pressure and higher vasoactive-inotropic score. Cardiopulmonary bypass was strongly associated with any acute kidney injury, although not stage 2/3 acute kidney injury. Stage 2/3 acute kidney injury is a compelling risk factor for longer cardiovascular ICU and hospital postoperative length of stay. Increased attention to and management of renal perfusion pressure may reduce postoperative acute kidney injury and improve outcomes.
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Drug-associated acute kidney injury: who's at risk? Pediatr Nephrol 2017; 32:59-69. [PMID: 27338726 PMCID: PMC5826624 DOI: 10.1007/s00467-016-3446-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/02/2016] [Accepted: 06/08/2016] [Indexed: 02/07/2023]
Abstract
The contribution of nephrotoxic medications to the development of acute kidney injury (AKI) is becoming better understood concomitant with the increased incidence of AKI in children. Treatment of AKI is not yet available, so prevention continues to be the most effective approach. There is an opportunity to mitigate severity and prevent the occurrence of AKI if children at increased risk are identified early and nephrotoxins are used judiciously. Early detection of AKI is limited by the dependence of nephrologists on serum creatinine as an indicator. Promising new biomarkers may offer early detection of AKI prior to the rise in serum creatinine. Early detection of evolving AKI is improving and offers opportunities for better management of nephrotoxins. However, the identification of patients at increased risk will remain an important first step, with a focus on the use of biomarker testing and interpretation of the results.
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