Acute Kidney Injury and Renal Tubular Damage in Children With Type 1 Diabetes Mellitus Onset

Marzuillo, Pierluigi; Iafusco, Dario; Zanfardino, Angela; Guarino, Stefano; Piscopo, Alessia; Casaburo, Francesca; Capalbo, Daniela; Ventre, Maria; Arienzo, Maria Rosaria; Cirillo, Grazia; Picione, Carla De Luca; Esposito, Tiziana; Montaldo, Paolo; Sessa, Anna Di; Giudice, Emanuele Miraglia del

doi:10.1210/clinem/dgab090

Cited by 32 publications

(83 citation statements)

References 29 publications

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“…We considered the patient as affected by RTD if they presented with one or more abnormal values among urinary levels of beta-2-microglobulin >0.33 mg/L, tubular reabsorption of phosphate (TRP) <85%, or FENa >2% [8].…”

Section: Renal Tubular Damagementioning

confidence: 99%

“…The fractional excretion of Na (FENa) was calculated with the formula: FENa (%) = ((U Na /U Cr )/(P Na /P Cr )) × 100 [8].…”

Section: Other Definitionsmentioning

confidence: 99%

“…Nephrological complications can also occur, especially in children with T1DM. Acute kidney injury (AKI) and renal tubular damage (RTD) are frequent in hospitalized patients for DKA [7,8]. Hursh et al, in their monocenter study, showed that 64.2% of the 165 retrospectively enrolled children showing DKA at the T1DM onset presented with AKI [7], according to the Kidney Disease/Improving Global Outcomes (KDIGO) creatinine criteria [9].…”

Section: Introductionmentioning

confidence: 99%

“…We showed that 65.2% of the children with DKA and 21.1% of those without DKA at T1DM onset presented AKI, while 73.5% of the children with T1DM onset presented RTD. All patients with DKA or AKI presented with RTD [8].…”

Section: Introductionmentioning

confidence: 99%

“…Taking advantage of the DiAKIdney (onset of type 1 Diabetes mellitus and Acute Kidney Injury) study's prospective data collection [8], we analyzed the data of patients admitted with the diagnosis of T2DM in the study period. We aimed to evaluate the prevalence and the possible features of AKI and RTD in children with T2DM.…”

Section: Introductionmentioning

confidence: 99%

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Renal Involvement in Children with Type 2 Diabetes Mellitus Onset: A Pilot Study

et al. 2021

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Type 2 Diabetes Mellitus (T2DM) is a main cause of chronic kidney disease (CKD) in adulthood. No studies have examined the occurrence of acute kidney injury (AKI)—that enhances the risk of later CKD—and renal tubular damage (RTD)—that can evolve to AKI—in children with onset of T2DM. We aimed to evaluate the prevalence and possible features of AKI and RTD in a prospectively enrolled population of children with onset of T2DM. We consecutively enrolled 10 children aged 12.9 ± 2.3 years with newly diagnosed T2DM. AKI was defined according to the KDIGO criteria. RTD was defined by abnormal urinary beta-2-microglobulin and/or tubular reabsorption of phosphate (TRP) < 85% and/or fractional excretion of Na > 2%. None of the patients developed AKI, whereas 3/10 developed RTD with high beta-2-microglobulin levels (range: 0.6–1.06 mg/L). One of these three patients also presented with reduced TRP levels (TRP = 70%). Proteinuria was observed in two out of three patients with RTD, while none of patients without RTD had proteinuria. Patients with RTD presented higher beta-2-microglobulin, acute creatinine/estimated basal creatinine ratio, and serum ketones levels compared with patients without RTD. In conclusion, in our pilot observation, we found that none of the 10 children with T2DM onset developed AKI, whereas three of them developed RTD.

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Section: Renal Tubular Damagementioning

confidence: 99%

“…The fractional excretion of Na (FENa) was calculated with the formula: FENa (%) = ((U Na /U Cr )/(P Na /P Cr )) × 100 [8].…”

Section: Other Definitionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Renal Involvement in Children with Type 2 Diabetes Mellitus Onset: A Pilot Study

et al. 2021

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Determinants of acute kidney injury in children with new onset type 1 diabetes: A cohort study of children aged <15 years: Auckland, New Zealand (2006–2016)

Pittman

Soma

Wong

et al. 2022

Endocrino Diabet & Metabol

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Objective Acute kidney injury (AKI) may contribute to the risk of diabetic kidney disease, however, there have been limited studies of the incidence of AKI in well‐defined populations of children with type 1 diabetes. The aim was to quantify AKI in children presenting with new onset type 1 diabetes from the regional paediatric diabetes service, Auckland, New Zealand. Research Design and Methods A retrospective analysis of a prospectively identified cohort study of children and adolescents presenting from 2006 to 2016 with type 1 diabetes aged <15 years. AKI was defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. Results There were 586 subjects: 52% male, with mean (SD) age 8.9 (3.8) years, with 151(25.8%) in diabetic ketoacidosis (DKA). AKI was present in 47%, 278/586, AKI was increased in those with DKA (125/151 (83%) DKA vs. 153/435 (35%) no‐DKA). Univariable analysis showed that increased HbA1c, higher glucose levels, lower BMI SDS, lower bicarbonate and pH levels were all associated with AKI (p < .001). In multivariable analysis, AKI was associated with DKA and higher glucose levels independently. The majority of cases were stage 1 (203/278 [73%]), or stage 2 AKI 62/278 (22%). 13/278 (5%) had severe, Stage 3 AKI, and all presented in DKA (13/151 (8%) vs. 0/435 (0%) without DKA, p < .001). Conclusion In this regional paediatric, cohort AKI is a common complication of children presenting with new onset type 1 diabetes. AKI is independently associated with higher glucose levels and DKA, and all cases of Stage 3 AKI were associated with DKA.

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Heart rate cut-offs to identify non-febrile children with dehydration and acute kidney injury

et al. 2022

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We hypothesized that the heart rate (HR) variation in an acute setting compared with HR in wellbeing status could be a good marker of both dehydration and acute kidney injury (AKI). Since HR in wellbeing status is unknown in most cases, we assumed as reliable surrogate the 50th percentile of HR according to age and gender. We evaluated if the estimated percentage of heart rate variation in acute setting compared with 50th percentile of HR (EHRV) could be marker of dehydration and AKI in children. Two independent cohorts, one prospective comprehending 185 children at type 1 diabetes mellitus onset (derivation) and one retrospective comprehending 151 children with acute gastroenteritis and pneumonia (validation), were used to develop and externally validate EHRV as predictor of the ≥ 5% dehydration and/or AKI composite outcome. Febrile patients were excluded. EHRV was calculated as ((HR at admission–50th percentile of HR)/HR at admission) × 100. The prevalences of ≥ 5% dehydration and AKI were 61.1% and 43.8% in the derivation and 34.4% and 24.5% in the validation cohort. For the ≥ 5% dehydration and/or AKI composite outcome, the area under receiver-operating characteristic curve of the EHRV in the derivation cohort was 0.69 (95%CI, 0.62–0.77; p < 0.001) and the best EHRV cut-off was > 24.5%. In the validation cohort, EHRV > 24.5% showed specificity = 100% (95%CI, 96.2–100.0), positive predictive value = 100%, and negative predictive value = 67.1% (95%CI, 64.7–69.5). The positive likelihood ratio was infinity, and odds ratio was not calculable because all the patients with EHRV > 24.5% showed ≥ 5% dehydration and/or AKI. Conclusions: EHRV appears a rather reliable marker of dehydration and AKI. Further validations could allow implementing EHRV in the clinical practice. What is Known:• Increased heart rate (HR) is an easily and quickly detectable sign of dehydration in childhood, but its cut-off to suspect dehydration or acute kidney injury (AKI) is not defined. What is New:• We found that a percentage of estimated HR variation in acute setting in comparison with 50th percentile of HR (EHRV)>24.5% predicted ≥5% dehydration and/or AKI in non-febrile patients.• We provide a one-page tool to suspect ≥5% dehydration and/or AKI on the basis of the HR. If furtherly validated, this tool could be implemented in the daily clinical practice.

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Acute Kidney Injury and Renal Tubular Damage in Children With Type 1 Diabetes Mellitus Onset

Cited by 32 publications

References 29 publications

Renal Involvement in Children with Type 2 Diabetes Mellitus Onset: A Pilot Study

Renal Involvement in Children with Type 2 Diabetes Mellitus Onset: A Pilot Study

Determinants of acute kidney injury in children with new onset type 1 diabetes: A cohort study of children aged <15 years: Auckland, New Zealand (2006–2016)

Heart rate cut-offs to identify non-febrile children with dehydration and acute kidney injury

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