Acute kidney injury in children with nephrotic syndrome: a single-center study

Abstract

BackgroundChildren with nephrotic syndrome (NS) are at risk for the development of acute kidney injury (AKI) through a variety of mechanisms.The frequency of NS hospitalizations complicated by AKI has almost doubled in the last decade. Children with AKI have longer hospital length of stay and increased need for intensive care unit admission. The main objectives of this study were to determine the incidence, clinical characteristics, risk factors and short-term outcome of AKI in children hospitalized with NS.MethodsIn this retrospective study, 355 children ≤18 years of age with a clinical diagnosis of NS admitted in the Department of Nephrology, Gauhati Medical College and Hospital from January 2012 to December 2015 were reviewed.ResultsThe incidence of AKI in children with NS was found to be 23.66%, 11.24%, 7.95% and 4.48% of children entered Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) Stages R, I and F, respectively. Infection {odds ratio [OR] 2.53 [95% confidence interval (CI) 1.52–4.22]} and nephrotoxic medication exposure [OR 7.8 (95% CI 4.06–15.01)] were common factors associated with AKI. Children with steroid-dependent NS (SDNS) and steroid-resistant NS (SRNS) were more likely to develop AKI compared with children with steroid-sensitive NS (SSNS). The mean time to recovery for groups pRIFLE Stages R, I and F were 15 ± 2 , 22 ± 3 and 28 ± 5 days, respectively. Children with NS who were hypertensive, had higher urinary protein excretion and low serum albumin were more prone to develop AKI.ConclusionsAKI is not uncommon in children with NS. Infection and exposure to nephrotoxic drugs are common factors associated with AKI. AKI is more frequent in SDNS and SRNS compared with SSNS. The mean time to recovery is prolonged with more severe AKI.

Acute kidney injury in idiopathic membranous nephropathy with nephrotic syndrome

“…Our results suggest AKI may affect remission of NS in iMN patients. Complete remission rate was obvious lower in AKI patients than No AKI patients.Some studies also showed similar results that severe AKI needed more time to remission in NS patients [6,[8][9][10]. Complete renal function recovery rate was only 53.2% in this study, which was obviously lower than in MCD patients in previous reports [8][9][10].…”

“…Patients with iMN are significantly burdened with high disease severity and adverse health outcomes, resulting in substantial health care resource utilization and costs [5]. Many reports focused on acute kidney injury (AKI) in NS patients in recent years [6][7][8][9]. Our previous study showed 95 (34%) patients of all 277 primary NS had AKI [10].…”

Changing epidemiology of nephrotic syndrome in Nigerian children: A cross-sectional study

“…While the lower serum creatinine in those with SSNS may be explained by the predominance of SSNS in younger children, the higher estimated GFR values suggest that the kidney function of children with SSNS may be better than those with SRNS. Other studies have observed that children with SRNS have poorer kidney function and more rates of acute kidney injury at diagnosis of nephrotic syndrome than those with SSNS [ 29 , 30 ]. This is not unexpected because SRNS is more likely associated with a more severe kidney pathology such as focal segmental glomerulosclerosis and membranoproliferative glomerulonephritis than SSNS.…”

Acute Kidney Injury in Nephrotic Syndrome

“…The rate increases with newer definition of AKI and when more detailed chart review is done. In a single center study from India, Sharma et al looked at AKI in 355 children with NS (10, 11). They defined AKI using the pediatric modification of RIFLE criteria (p-RIFLE) (11).…”

“…These children were also more likely to require ICU care. Sharma et al reported that the mean time to recovery of renal function increased with severity of AKI ranging from 15 ± 2 days for AKI stage R to 28 ± 5 days for AKI stage F (10).…”