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Sun Q, Pan Y, Li Z. Acute kidney injury in hospitalized children in 20 hospitals of China's Hunan Province: a cross-sectional survey. Ren Fail 2024; 46:2379003. [PMID: 39082671 PMCID: PMC11293263 DOI: 10.1080/0886022x.2024.2379003] [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: 08/01/2023] [Revised: 06/26/2024] [Accepted: 07/07/2024] [Indexed: 08/03/2024] Open
Abstract
OBJECTIVE The incidence of acute kidney injury (AKI) in pediatric patients has been increasing over the years, and AKI significantly impacts children's health and quality of life. This article reviews the current epidemiological research on pediatric AKI. METHODS The clinical data of hospitalized children aged 0 to 14 years from 20 different hospitals in Hunan Province, China, collected from December 2017 to February 2018, were analyzed. The incidence rate, misdiagnosis rate, main causes, and medical costs of AKI in hospitalized children were examined. RESULTS A total of 29,639 patients were included, with an AKI incidence rate of 4.34% (1286/29,639). Among the 1286 AKI patients, 863 (67.11%) were classified as AKI stage 1324 (25.19%) as AKI stage 2, and 99 (7.7%) as AKI stage 3. AKI patients had significantly longer hospital stays [6.0 (4.0, 10) days vs. 6.0 (4.0, 8.0) days, p < 0.001] and higher hospitalization costs [3375.22 (1600, 6083.83) yuan vs. 2729.4 (1659.45, 8216.65) yuan, p = 0.003] than non-AKI patients. The mortality rate (1.2% vs. 0.1%, p < 0.001), intensive care unit (ICU) transfer rate (8.7% vs. 5.97%, p < 0.001), and use of invasive mechanical ventilation (3.6% vs. 1%, p < 0.001) were significantly greater in patients with AKI than in those without AKI patients. The etiology of AKI varied among different age groups, and dehydration, diarrhea, and shock were the main causes of pre-renal AKI. CONCLUSION The incidence and missed diagnosis rates of AKI in hospitalized children were high. AKI prolongs hospital stays, increases hospitalization costs, and increases the risk of mortality in children.
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Affiliation(s)
- Qianliang Sun
- The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University (Hunan Children’s Hospital), Nephrology and Rheumatology, Changsha, China
| | - Ying Pan
- The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University (Hunan Children’s Hospital), Rehabilitation Center, Changsha, China
| | - Zhihui Li
- The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University (Hunan Children’s Hospital), Nephrology and Rheumatology, Changsha, China
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2
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Gorga SM, Selewski DT, Goldstein SL, Menon S. An update on the role of fluid overload in the prediction of outcome in acute kidney injury. Pediatr Nephrol 2024; 39:2033-2048. [PMID: 37861865 DOI: 10.1007/s00467-023-06161-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 10/21/2023]
Abstract
Over the past two decades, our understanding of the impact of acute kidney injury, disorders of fluid balance, and their interplay have increased significantly. In recent years, the epidemiology and impact of fluid balance, including the pathologic state of fluid overload on outcomes has been studied extensively across multiple pediatric and neonatal populations. A detailed understating of fluid balance has become increasingly important as it is recognized as a target for intervention to continue to work to improve outcomes in these populations. In this review, we provide an update on the epidemiology and outcomes associated with fluid balance disorders and the development of fluid overload in children with acute kidney injury (AKI). This will include a detailed review of consensus definitions of fluid balance, fluid overload, and the methodologies to define them, impact of fluid balance on the diagnosis of AKI and the concept of fluid corrected serum creatinine. This review will also provide detailed descriptions of future directions and the changing paradigms around fluid balance and AKI in critical care nephrology, including the incorporation of the sequential utilization of risk stratification, novel biomarkers, and functional kidney tests (furosemide stress test) into research and ultimately clinical care. Finally, the review will conclude with novel methods currently under study to assess fluid balance and distribution (point of care ultrasound and bioimpedance).
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Affiliation(s)
- Stephen M Gorga
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - David T Selewski
- Department of Pediatrics, Medical University of South Carolina, 125 Doughty St., MSC 608 Ste 690, Charleston, SC, 29425, USA.
| | - Stuart L Goldstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Shina Menon
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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3
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Joerger T, Hayes M, Stinson C, Mikhail I, Downes KJ. Incidence of Antimicrobial-Associated Acute Kidney Injury in Children: A Structured Review. Paediatr Drugs 2024; 26:59-70. [PMID: 38093147 PMCID: PMC10983053 DOI: 10.1007/s40272-023-00607-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 01/06/2024]
Abstract
Acute kidney injury (AKI) is a commonly reported adverse effect of administration of antimicrobials. While AKI can be associated with poorer outcomes, there is little information available to understand rates of AKI in children exposed to various antimicrobials. We performed a structured review using the PubMed and Embase databases. Articles were included if they provided an AKI definition in patients who were < 19 years of age receiving an antimicrobial and reported the frequency of AKI. Author-defined AKI rates were calculated for each study and mean pooled estimates for each antimicrobial were derived from among all study participants. Pooled estimates were also derived for those studies that reported AKI according to pRIFLE (pediatric risk, injury, failure, loss, end stage criteria), AKIN (acute kidney injury network), or KDIGO (kidney disease improving global outcomes) creatinine criteria. A total of 122 studies evaluating 28 antimicrobials met the inclusion criteria. Vancomycin was the most commonly studied drug: 11,514 courses across 44 included studies. Among the 27,285 antimicrobial exposures, the overall AKI rate was 13.2% (range 0-42.1% by drug), but the rate of AKI varied widely across studies (range 0-68.8%). Cidofovir (42.1%) and conventional amphotericin B (37.0%) had the highest pooled rates of author-defined AKI. Eighty-one studies used pRIFLE, AKIN, or KDIGO AKI criteria and the pooled rates of AKI were similar to author-defined AKI rates. In conclusion, antimicrobial-associated AKI is reported to occur frequently in children, but the rates of AKI varies widely across studies and drugs. Most published studies examined hospitalized patients and heterogeneity in study populations and in author definitions of AKI are barriers to a comparison of nephrotoxicity risk among antimicrobials in children.
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Affiliation(s)
- Torsten Joerger
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Infectious Diseases, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Molly Hayes
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Connor Stinson
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Ibram Mikhail
- Division of Infectious Diseases, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Kevin J Downes
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Infectious Diseases, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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4
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Wang R, An Y, Xu Y, Li C, Wang Q, Zou Y, Wang G. Exploring anti-acute kidney injury mechanism of Dahuang-Gancao decoction by network pharmacology and experimental validation. Aging (Albany NY) 2023; 15:10072-10088. [PMID: 37724901 PMCID: PMC10599760 DOI: 10.18632/aging.205033] [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: 04/12/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023]
Abstract
This study aimed to investigate the pharmacological effects and molecular mechanisms of Dahuang-Gancao Decoction (DHGC) on acute kidney injury (AKI). Network pharmacology was utilized to analyze the key targets of DHGC against AKI. These targets were used to construct a protein-protein interaction (PPI) network, which was analyzed using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment to predict the mechanism of action. Based on the network pharmacological analysis, Sirtuin 3 (SIRT3) was identified as a key target, and apoptosis was suggested as a mechanism of DHGC for AKI treatment. Subsequently, an AKI mouse model was induced using lipopolysaccharide (LPS), and the study demonstrated that DHGC gradient intervention significantly reduced plasma urea and creatinine levels in AKI mice, ameliorated renal pathological changes, reduced apoptosis, and lowered serum inflammatory factors. The mechanism of DHGC's anti-AKI effect may lie in the activation of the SIRT3/NRF2/HO-1 signaling pathway, which plays an antiapoptotic role in renal cells. In summary, DHGC improved LPS-induced AKI in mice by activating the SIRT3/NRF2/HO-1 signaling pathway. These findings shed light on the potential clinical application of DHGC for the treatment of nephropathy.
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Affiliation(s)
- Rui Wang
- Department of Oncology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430065, P.R. China
| | - Yi An
- Department of Endocrinology, Second Affiliated Hospital of Wuhan University of Science and Technology, Wuhan 430065, P.R. China
| | - Yifang Xu
- Department of Oncology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430065, P.R. China
| | - Chengyin Li
- Department of Oncology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430065, P.R. China
| | - Qiyuan Wang
- Department of Oncology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430065, P.R. China
| | - Yinshui Zou
- Department of Oncology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430065, P.R. China
| | - Guangzhi Wang
- Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian 116023, P.R. China
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5
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Robinson CH, Iyengar A, Zappitelli M. Early recognition and prevention of acute kidney injury in hospitalised children. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:657-670. [PMID: 37453443 DOI: 10.1016/s2352-4642(23)00105-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 07/18/2023]
Abstract
Acute kidney injury is common in hospitalised children and is associated with poor patient outcomes. Once acute kidney injury occurs, effective therapies to improve patient outcomes or kidney recovery are scarce. Early identification of children at risk of acute kidney injury or at an early injury stage is essential to prevent progression and mitigate complications. Paediatric acute kidney injury is under-recognised by clinicians, which is a barrier to optimisation of inpatient care and follow-up. Acute kidney injury definitions rely on functional biomarkers (ie, serum creatinine and urine output) that are inadequate, since they do not account for biological variability, analytical issues, or physiological responses to volume depletion. Improved predictive tools and diagnostic biomarkers of kidney injury are needed for earlier detection. Novel strategies, including biomarker-guided care algorithms, machine-learning methods, and electronic alerts tied to clinical decision support tools, could improve paediatric acute kidney injury care. Clinical prediction models should be studied in different paediatric populations and acute kidney injury phenotypes. Research is needed to develop and test prevention strategies for acute kidney injury in hospitalised children, including care bundles and therapeutics.
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Affiliation(s)
- Cal H Robinson
- Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, ON, Canada
| | - Arpana Iyengar
- Department of Paediatric Nephrology, St John's National Academy of Health Sciences, Bangalore, India
| | - Michael Zappitelli
- Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
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6
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Plumb L, Casula A, Sinha MD, Inward CD, Marks SD, Medcalf J, Nitsch D. Epidemiology of childhood acute kidney injury in England using e-alerts. Clin Kidney J 2023; 16:1288-1297. [PMID: 37529656 PMCID: PMC10387403 DOI: 10.1093/ckj/sfad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Indexed: 08/03/2023] Open
Abstract
Background Few studies describe the epidemiology of childhood acute kidney injury (AKI) nationally. Laboratories in England are required to issue electronic (e-)alerts for AKI based on serum creatinine changes. This study describes a national cohort of children who received an AKI alert and their clinical course. Methods A cross-section of AKI episodes from 2017 are described. Hospital record linkage enabled description of AKI-associated hospitalizations including length of stay (LOS) and critical care requirement. Risk associations with critical care (hospitalized cohort) and 30-day mortality (total cohort) were examined using multivariable logistic regression. Results In 2017, 7788 children (52% male, median age 4.4 years, interquartile range 0.9-11.5 years) experienced 8927 AKI episodes; 8% occurred during birth admissions. Of 5582 children with hospitalized AKI, 25% required critical care. In children experiencing an AKI episode unrelated to their birth admission, Asian ethnicity, young (<1 year) or old (16-<18 years) age (reference 1-<5 years), and high peak AKI stage had higher odds of critical care. LOS was higher with peak AKI stage, irrespective of critical care admission. Overall, 30-day mortality rate was 3% (n = 251); youngest and oldest age groups, hospital-acquired AKI, higher peak stage and critical care requirement had higher odds of death. For children experiencing AKI alerts during their birth admission, no association was seen between higher peak AKI stage and critical care admission. Conclusions Risk associations for adverse AKI outcomes differed among children according to AKI type and whether hospitalization was related to birth. Understanding the factors driving AKI development and progression may help inform interventions to minimize morbidity.
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Affiliation(s)
| | - Anna Casula
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | - Manish D Sinha
- Evelina London Children's Hospital, Guys and St Thomas’ NHS Foundation Trust, London, UK
- British Heart Foundation Centre, Kings College London, London, UK
| | - Carol D Inward
- Department of Paediatric Nephrology, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - James Medcalf
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Dorothea Nitsch
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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7
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Schuermans A, Van den Eynde J, Mekahli D, Vlasselaers D. Long-term outcomes of acute kidney injury in children. Curr Opin Pediatr 2023; 35:259-267. [PMID: 36377251 DOI: 10.1097/mop.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) affects up to 35% of all critically ill children and is associated with substantial short-term morbidity and mortality. However, the link between paediatric AKI and long-term adverse outcomes remains incompletely understood. This review highlights the most recent clinical data supporting the role of paediatric AKI as a risk factor for long-term kidney and cardiovascular consequences. In addition, it stresses the need for long-term surveillance of paediatric AKI survivors. RECENT FINDINGS Recent large-scale studies have led to an increasing understanding that paediatric AKI is a significant risk factor for adverse outcomes such as hypertension, cardiovascular disease and chronic kidney disease (CKD) over time. These long-term sequelae of paediatric AKI are most often observed in vulnerable populations, such as critically ill children, paediatric cardiac surgery patients, children who suffer from severe infections and paediatric cancer patients. SUMMARY A growing body of research has shown that paediatric AKI is associated with long-term adverse outcomes such as CKD, hypertension and cardiovascular disease. Although therapeutic pathways tailored to individual paediatric AKI patients are yet to be validated, we provide a framework to guide monitoring and prevention in children at the highest risk for developing long-term kidney dysfunction.
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Affiliation(s)
- Art Schuermans
- PKD Research Group, Department of Cellular and Molecular Medicine, KU Leuven
| | - Jef Van den Eynde
- PKD Research Group, Department of Cellular and Molecular Medicine, KU Leuven
| | - Djalila Mekahli
- PKD Research Group, Department of Cellular and Molecular Medicine, KU Leuven
- Department of Pediatric Nephrology, University Hospitals Leuven
| | - Dirk Vlasselaers
- Department of Intensive Care Medicine, University Hospitals Leuven
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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8
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Khandelwal P, McLean N, Menon S. Update on Pediatric Acute Kidney Injury. Pediatr Clin North Am 2022; 69:1219-1238. [PMID: 36880931 DOI: 10.1016/j.pcl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Acute kidney injury (AKI) is common in children and is associated with significant morbidity and mortality. In the last decade our understanding of AKI has improved significantly, and it is now considered a systemic disorder that affects other organs including heart, lung, and brain. In spite of its limitations, serum creatinine remains the mainstay in the diagnosis of AKI. However, newer approaches such as urinary biomarkers, furosemide stress test, and clinical decision support are being increasingly used and have the potential to improve the accuracy and timeliness of AKI diagnosis.
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Affiliation(s)
- Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Academic Block, Ansari Nagar, New Delhi 110029, India
| | - Nadia McLean
- Cornwall Regional Hospital, c/o Cornwall Regional Hospital, PO Box 900, Mount Salem, Montego Bay #2 PO, St. James, Jamaica, West Indies
| | - Shina Menon
- Department of Pediatrics, Division of Nephrology, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Mailstop OC9.820, Seattle, WA 98103, USA.
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Deng YH, Luo XQ, Yan P, Zhang NY, Liu Y, Duan SB. Outcome prediction for acute kidney injury among hospitalized children via eXtreme Gradient Boosting algorithm. Sci Rep 2022; 12:8956. [PMID: 35624143 PMCID: PMC9142505 DOI: 10.1038/s41598-022-13152-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/09/2022] [Indexed: 11/18/2022] Open
Abstract
Acute kidney injury (AKI) is common among hospitalized children and is associated with a poor prognosis. The study sought to develop machine learning-based models for predicting adverse outcomes among hospitalized AKI children. We performed a retrospective study of hospitalized AKI patients aged 1 month to 18 years in the Second Xiangya Hospital of Central South University in China from 2015 to 2020. The primary outcomes included major adverse kidney events within 30 days (MAKE30) (death, new renal replacement therapy, and persistent renal dysfunction) and 90-day adverse outcomes (chronic dialysis and death). The state-of-the-art machine learning algorithm, eXtreme Gradient Boosting (XGBoost), and the traditional logistic regression were used to establish prediction models for MAKE30 and 90-day adverse outcomes. The models’ performance was evaluated by split-set test. A total of 1394 pediatric AKI patients were included in the study. The incidence of MAKE30 and 90-day adverse outcomes was 24.1% and 8.1%, respectively. In the test set, the area under the receiver operating characteristic curve (AUC) of the XGBoost model was 0.810 (95% CI 0.763–0.857) for MAKE30 and 0.851 (95% CI 0.785–0.916) for 90-day adverse outcomes, The AUC of the logistic regression model was 0.786 (95% CI 0.731–0.841) for MAKE30 and 0.759 (95% CI 0.654–0.864) for 90-day adverse outcomes. A web-based risk calculator can facilitate the application of the XGBoost models in daily clinical practice. In conclusion, XGBoost showed good performance in predicting MAKE30 and 90-day adverse outcomes, which provided clinicians with useful tools for prognostic assessment in hospitalized AKI children.
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Affiliation(s)
- Ying-Hao Deng
- Department of Nephrology, Hunan Key Laboratory of Kidney Disease and Blood Purification, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Xiao-Qin Luo
- Department of Nephrology, Hunan Key Laboratory of Kidney Disease and Blood Purification, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Ping Yan
- Department of Nephrology, Hunan Key Laboratory of Kidney Disease and Blood Purification, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Ning-Ya Zhang
- Information Center, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yu Liu
- Department of Nephrology, Hunan Key Laboratory of Kidney Disease and Blood Purification, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Shao-Bin Duan
- Department of Nephrology, Hunan Key Laboratory of Kidney Disease and Blood Purification, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.
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10
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Rodríguez-Durán A, Martínez-Urbano J, Laguna-Castro M, Crespo-Montero R. Lesión renal aguda en el paciente pediátrico: revisión integrativa. ENFERMERÍA NEFROLÓGICA 2022. [DOI: 10.37551/s2254-28842022002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introducción: La lesión renal aguda se ha convertido en una complicación común en los niños hospitalizados, especialmente cuando están en una situación clínica crítica. Objetivo: Conocer y sintetizar la bibliografía científica más actualizada sobre la lesión renal aguda en la población pediátrica. Metodología: Estudio descriptivo de revisión integrativa. La búsqueda de artículos se ha realizado en las bases de datos Pubmed, Scopus y Google Scholar. La estrategia de búsqueda se estableció con los siguientes términos MeSH: ”acute kidney injury”, “children” y “pediatric”. La calidad metodológica se realizó mediante la escala STROBE. Resultados: Se incluyeron 35 artículos, 19 de diseño observacional retrospectivo, 12 observacionales prospectivos, 3 revisiones bibliográficas y 1 estudio cualitativo. No hay variables sociodemográficas destacables que impliquen mayor probabilidad de presentar lesión renal aguda. Tanto la etiología como los factores de riesgo son muy variables. La lesión renal aguda se asocia a mayor número de complicaciones y estancia hospitalaria. No hay evidencia de cuidados enfermeros en la lesión renal aguda en pacientes pediátricos. Conclusiones: Se observa una falta de homogeneidad en los criterios de definición, incidencia, etiología, factores de riesgo y de tratamiento en los pacientes pediátricos con lesión renal aguda, y escasez de artículos originales de investigación. La lesión renal aguda pediátrica se asocia a mayor mortalidad, morbilidad, mayor estancia hospitalaria y mayor duración de la ventilación mecánica. El papel de enfermería en el manejo del tratamiento conservador y de las terapias de reemplazo renal de este cuadro, es fundamental en la supervivencia de estos pacientes.
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Affiliation(s)
- Ana Rodríguez-Durán
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España
| | - Julia Martínez-Urbano
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España
| | - Marta Laguna-Castro
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España
| | - Rodolfo Crespo-Montero
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. Servicio de Nefrología. Hospital Universitario Reina Sofía de Córdoba. Instituto Maimónides de Investigación Biomédica de Córdoba. España
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11
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Jones K, Neu A, Fadrowski J. AKI in Hospitalized Children: Poorly Documented (and Underrecognized). Front Pediatr 2022; 9:790509. [PMID: 35083185 PMCID: PMC8784800 DOI: 10.3389/fped.2021.790509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Acute kidney injury (AKI) is common in hospitalized children. We hypothesized that hospital-acquired AKI would be underrecognized and under-reported, with potential implications for prevention of future AKI and CKD risk stratification. Methods: Five hundred thirty-two cases of AKI occurring over a 1 year period in a tertiary children's hospital in the United States were studied. AKI documentation was defined as any mention of AKI in the admission history and physical note, progress notes, or discharge summary. Nephrology follow-up was defined as a completed outpatient clinic visit within 1 year of discharge. Logistic regression was used to assess factors associated with documentation, consultation, and follow-up. Results: AKI developed during 584/7,640 (7.6%) of hospitalizations: 532 cases met inclusion criteria. Documentation was present in 34% (185/532) of AKI cases and 90 (16.9%) had an inpatient nephrology consult. Among 501 survivors, 89 (17.8%) had AKI in their hospital discharge summary and 54 had outpatient nephrology follow up. Stage 3 AKI, peak creatinine >1 mg/dL and longer length of stay were associated with documentation. Stage 3 AKI and higher baseline creatinine were associated with inpatient nephrology consultation. Inpatient nephrology consultation was positively associated with outpatient nephrology follow up, but documentation in the discharge summary was not. Conclusion: Most cases of AKI were not documented and the proportion of children seen by a nephrologist was low, even among those with more severe injury. Increased severity of AKI was associated with documentation and inpatient consultation. Poor rates of documentation has implications for AKI recognition and appropriate management and follow up.
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Affiliation(s)
- Katherine Jones
- Division of Pediatric Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, United States
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12
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Dharnidharka VR, Ciccia EA, Goldstein SL. Acute Kidney Injury in Children: Being AWARE. Pediatrics 2020; 146:peds.2020-0880. [PMID: 32784226 DOI: 10.1542/peds.2020-0880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Vikas R Dharnidharka
- Division of Pediatric Nephrology, Hypertension, and Pheresis, School of Medicine, Washington University in St Louis and St Louis Children's Hospital, St Louis, Missouri; and
| | - Eileen A Ciccia
- Division of Pediatric Nephrology, Hypertension, and Pheresis, School of Medicine, Washington University in St Louis and St Louis Children's Hospital, St Louis, Missouri; and
| | - Stuart L Goldstein
- Division of Nephrology and Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
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