Acute Kidney Injury Is Common in Pediatric Severe Malaria and Is Associated With Increased Mortality

被引：89

作者：

Conroy, Andrea L. ^{[1
,2
]}

Hawkes, Michael ^{[1
,3
]}

Elphinstone, Robyn E. ^{[1
]}

Morgan, Catherine ^{[4
]}

Hermann, Laura ^{[1
]}

Barker, Kevin R. ^{[1
]}

Namasopo, Sophie ^{[5
]}

Opoka, Robert O. ^{[6
,7
]}

John, Chandy C. ^{[2
]}

Liles, W. Conrad ^{[8
]}

Kain, Kevin C. ^{[1
,9
]}

机构：

[1] Univ Toronto, Toronto Gen Hosp, Sandra Rotman Ctr Global Hlth, Sandra A Rotman Labs,Univ Hlth Network, Toronto, ON, Canada

[2] Indiana Univ, Dept Pediat, Indianapolis, IN 46204 USA

[3] Univ Alberta, Div Pediat Infect Dis, Edmonton, AB, Canada

[4] Univ Alberta, Div Pediat Nephrol, Edmonton, AB, Canada

[5] Jinja Reg Referral Hosp, Dept Pediat, Kampala, Uganda

[6] Mulago Hosp, Dept Paediat & Child Hlth, Kampala, Uganda

[7] Makerere Univ, Kampala, Uganda

[8] Univ Washington, Dept Med, Seattle, WA USA

[9] Univ Toronto, Dept Med, Div Infect Dis, Trop Dis Unit, Toronto, ON, Canada

来源：

OPEN FORUM INFECTIOUS DISEASES | 2016年 / 3卷 / 02期

基金：

加拿大健康研究院;

关键词：

acute kidney injury; children; creatinine; inhaled nitric oxide; severe malaria; GLOMERULAR-FILTRATION-RATE; ACUTE-RENAL-FAILURE; PLASMODIUM-FALCIPARUM MALARIA; INHALED NITRIC-OXIDE; SERUM CYSTATIN C; AFRICAN CHILDREN; CARDIAC-FUNCTION; KENYAN CHILDREN; DYSFUNCTION; DISEASE;

D O I：

10.1093/ofid/ofw046

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

071005 [微生物学]; 100108 [医学免疫学];

摘要：

Background. Acute kidney injury (AKI) is a well recognized complication of severe malaria in adults, but the incidence and clinical importance of AKI in pediatric severe malaria (SM) is not well documented. Methods. One hundred eighty children aged 1 to 10 years with SM were enrolled between 2011 and 2013 in Uganda. Kidney function was monitored daily for 4 days using serum creatinine (Cr). Acute kidney injury was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Blood urea nitrogen (BUN) and Cr were assessed using i-STAT, and cystatin C (CysC) was measured by enzyme-linked immunosorbent assay. Results. Eighty-one (45.5%) children had KDIGO-defined AKI in the study: 42 (51.9%) stage 1, 18 (22.2%) stage 2, and 21 (25.9%) stage 3. Acute kidney injury evolved or developed in 50% of children after admission of hospital. There was an increased risk of AKI in children randomized to inhaled nitric oxide (iNO), with 47 (54.0%) of children in the iNO arm developing AKI compared with 34 (37.4%) in the placebo arm (relative risk, 1.36; 95% confidence interval [CI], 1.03-1.80). Duration of hospitalization increased across stages of AKI (P=.002). Acute kidney injury was associated with neurodisability at discharge in the children receiving placebo (25% in children with AKI vs 1.9% in children with no AKI, P=.002). Mortality increased across stages of AKI (P=.006) in the placebo arm, reaching 37.5% in stage 3 AKI. Acute kidney injury was not associated with neurodisability or mortality at discharge in children receiving iNO (P>.05 for both). Levels of kidney biomarkers were predictive of mortality with areas under the curves (AUCs) of 0.80 (95% CI,.65-. 95; P=.006) and 0.72 (95% CI,.57-. 87; P<.001), respectively. Admission levels of CysC and BUN were elevated in children who died by 6 months (P<.0001 and P=.009, respectively). Conclusions. Acute kidney injury is an underrecognized complication in young children with SM and is associated with increased mortality.

引用

页数：9

共 41 条

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Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis [J].