AKI in Children Hospitalized with Nephrotic Syndrome

被引:79
作者
Rheault, Michelle N. [1 ]
Zhang, Lei [1 ]
Selewski, David T. [1 ]
Kallash, Mahmoud [1 ]
Tran, Cheryl L. [1 ]
Seamon, Meredith [1 ]
Katsoufis, Chryso [1 ]
Ashoor, Isa [1 ]
Hernandez, Joel [1 ]
Supe-Markovina, Katarina [1 ]
D'Alessandri-Silva, Cynthia [1 ]
DeJesus-Gonzalez, Nilka [1 ]
Vasylyeva, Tetyana L. [1 ]
Formeck, Cassandra [1 ]
Woll, Christopher [1 ]
Gbadegesin, Rasheed [1 ]
Geier, Pavel [1 ]
Devarajan, Prasad [1 ]
Carpenter, Shannon L. [1 ]
Kerlin, Bryce A. [1 ]
Smoyer, William E. [1 ]
机构
[1] Univ Minnesota, Masonic Childrens Hosp, Dept Pediat, Div Nephrol, Minneapolis, MN 55454 USA
来源
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2015年 / 10卷 / 12期
基金
美国国家卫生研究院;
关键词
ACUTE KIDNEY INJURY; CRITICALLY-ILL CHILDREN; INTENSIVE-CARE-UNIT; LENGTH-OF-STAY; RENAL-FAILURE; OUTCOMES; COHORT; STRATIFICATION; EPIDEMIOLOGY; ADOLESCENTS;
D O I
10.2215/CJN.06620615
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background and objectives Children with nephrotic syndrome can develop life-threatening complications, including infection and thrombosis. While AKI is associated with adverse outcomes in hospitalized children, little is known about the epidemiology of AKI in children with nephrotic syndrome. The main objectives of this study were to determine the incidence, epidemiology, and hospital outcomes associated with AKI in a modern cohort of children hospitalized with nephrotic syndrome. Design, setting, participants, & measurements Records of children with nephrotic syndrome admitted to 17 pediatric nephrology centers across North America from 2010 to 2012 were reviewed. AKI was classified using the pediatric RIFLE definition. Results AKI occurred in 58.6% of 336 children and 50.9% of 615 hospitalizations (27.3% in stage R, 17.2% in stage I, and 6.3% in stage F). After adjustment for race, sex, age at admission, and clinical diagnosis, infection (odds ratio, 2.24; 95% confidence interval, 1.37 to 3.65; P=0.001), nephrotoxic medication exposure (odds ratio, 1.35; 95% confidence interval, 1.11 to 1.64; P=0.002), days of nephrotoxic medication exposure (odds ratio, 1.10; 95% confidence interval, 1.05 to 1.15; P<0.001), and intensity of medication exposure (odds ratio, 1.34; 95% confidence interval, 1.09 to 1.65; P=0.01) remained significantly associated with AKI in children with nephrotic syndrome. Nephrotoxic medication exposure was common in this population, and each additional nephrotoxic medication received during a hospitalization was associated with 38% higher risk of AKI. AKI was associated with longer hospital stay after adjustment for race, sex, age at admission, clinical diagnosis, and infection (difference, 0.45 [log]days; 95% confidence interval, 0.36 to 0.53 [log]days; P<0.001). Conclusions AKI is common in children hospitalized with nephrotic syndrome and should be deemed the third major complication of nephrotic syndrome in children in addition to infection and venous thromboembolism. Risk factors for AKI include steroid-resistant nephrotic syndrome, infection, and nephrotoxic medication exposure. Children with AKI have longer hospital lengths of stay and increased need for intensive care unit admission.
引用
收藏
页码:2110 / 2118
页数:9
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