Objective: to know the epidemiology of Acute Kidney Injury (AKI) in the pediatric population at Hospital Universitario del Valle (HUV), a tertiary University Hospital in Cali, Colombia.
Methods: We obtained a series of cases through daily surveillance for a seven-month period (June 1 to December 31, 2009) in patients older than 30 days and under 18 years at HUV. We excluded patients with previous diagnosis of chronic renal failure. The new pRIFLE scale was used to define AKI.
Results: 27 patients were detected, with mean age of 36 months. Incidence of AKI was 0.38% from pediatric admissions and 6.2% from the pediatric intensive care unit (pICU) admissions. The pRIFLE scale at study entrance was: Risk: 2 patients, Injury: 8, Failure: 17. Etiology of AKI was: pre-renal in 89%, primary renal disease in 3.7%, and post-renal in 7.4%. There was an association of AKI with sepsis in 66.7% and 48.2% progressed to septic shock. Six patients required renal replacement therapy, all required peritoneal dialysis. The AKI was multi-factorial in 59.3% and associated with systemic multi-organ failure in 59.3%. At study entry, 63% patients were in pICU. The average hospital stay was 21.3 ± 9.2 days. Six children died, 16 resolved AKI, and nine were left with renal sequelae.
Conclusions: We recommended pRIFLE scale for early diagnosis of AKI in all pediatric services. Education in pRIFLE scale, prevention of AKI, and early management of sepsis and hypovolemia is recommended.
Resumen
El cáncer de vejiga es la undécima neoplasia maligna más frecuente a nivel mundial y conlleva una alta morbimortalidad. Para su diagnóstico, múltiples ayudas como la urotomografía y la cistoscopia, que permanecen como el estándar de oro en la actualidad. Se realizó una revisión narrativa en múltiples bases de datos (Medline, Scopus, ScienceDirect). El diagnóstico fotodinámico, al igual que la reconstrucción vesical por tomografía para realización de cistoscopia virtual son herramientas que se han introducido más recientemente. Asimismo, la ecografía contrastada y particularmente la Resonancia Magnética Multiparamétrica vesical con la clasificación de VI-RADS se han propuesto como alternativas novedosas. Éstos últimos son tal vez las herramientas más promisorias, sin embargo, se requieren más estudios que permitan recomendar su uso generalizado, que aún se vería limitado por su disponibilidad.
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