Acute kidney injury in infants hospitalized for viral bronchiolitis

Abstract

We investigated prevalence of and factors associated with acute kidney injury (AKI) in a group of patients hospitalized with viral bronchiolitis. We retrospectively enrolled 139 children (mean age = 3.2 ± 2.1 months; males = 58.9%) hospitalized for viral bronchiolitis in a non-pediatric intensive care unit (PICU) setting. The Kidney Disease/Improving Global Outcomes creatinine criterion was used to diagnose AKI. We estimated basal serum creatinine by back-calculating it by Hoste (age) equation assuming that basal eGFR were the median age-based eGFR normative values. Univariate and multivariate logistic regression models were used to explore associations with AKI. Out of 139 patients, AKI was found in 15 (10.8%). AKI was found in 13 out of 74 (17.6%) patients with and in 2 out of 65 (3.1%) without respiratory syncytial virus (RSV) infection (p = 0.006). No patient required renal replacement therapies, while 1 out of 15 (6.7%) developed AKI stage 3, 1 (6.7%) developed AKI stage 2, and 13 (86.6%) developed AKI stage 1. Among the 15 patients with AKI, 13 (86.6%) reached the maximum AKI stage at admission, 1 (6.7%) at 48 h, and 1 (6.7%) at 96 h. At multivariate analysis, birth weight < 10th percentile (odds ratio, OR = 34.1; 95% confidence interval, CI = 3.6–329.4; p = 0.002), preterm birth (OR = 20.3; 95% CI = 3.1–129.5; p = 0.002), RSV infection (OR = 27.0; 95% CI = 2.6–279.9; p = 0.006), and hematocrit levels > 2 standard deviation score (SDS) (OR = 22.4; 95% CI = 2.8–183.6; p = 0.001) were significantly associated with AKI.Conclusion: About 11% of patients hospitalized with viral bronchiolitis in a non-PICU setting develop an AKI (frequently mild in degree). Preterm birth, birth weight < 10th percentile, hematocrit levels > 2SDS, and RSV infection are significantly associated with AKI in the setting of viral bronchiolitis. What is Known:• Viral bronchiolitis affects children in the first months of life and in 7.5% of cases it can be complicated by acute kidney injury (AKI).• No studies investigated associations with AKI in infants hospitalized for viral bronchiolitis. What is New:• About 11% of patients hospitalized with viral bronchiolitis can develop an AKI (frequently mild in degree).• Preterm birth, birth weight <10th percentile, hematocrit levels > 2 standard deviation score, and respiratory syncytial virus infection are associated with AKI development in infants with viral bronchiolitis.

Gravedad y complicaciones en lactantes con infección por el virus respiratorio sincitial posterior a la pandemia por SARS-CoV-2

“…A pesar de la poca evidencia que muestra la relación del VRS con el desarrollo de lesión renal aguda, Marzuillo et al 13 encontraron en su serie de casos que el 10.8% desarrollaron lesión renal aguda, y de estos, el 86.7% tuvieron infección por VRS, lo cual concuerda con nuestro estudio, ya que la lesión renal aguda fue la principal manifestación extrapulmonar; sin embargo, en algunos pacientes se encontraron datos de insuficiencia cardiaca derecha. En el trabajo de Suárez et al 29 se calculó el IAR en los pacientes pediátricos con sepsis, y en el 30.5% se observó una puntuación ≥ 8, de los cuales el 8.6% requirieron terapia de sustitución renal.…”

“…Las complicaciones por VRS son diversas, pero destacan insuficiencia respiratoria, manifestaciones cardiacas (como taponamiento cardiaco, insuficiencia cardiaca, disfunción diastólica del ventrículo derecho y disfunción biventricular), complicaciones neurológicas (como encefalopatía) e interacciones pulmón-riñón, siendo la lesión renal aguda una de las principales, que se ha observado hasta en el 35% de los casos [9][10][11][12] . Se ha observado que hasta el 11% de los pacientes con bronquiolitis pueden desarrollar lesión renal aguda, y de estos, en el 86.7% fue secundaria a infección por VRS 13 .…”

Editorial on the Special Issue “Advances in Pediatric Acute Kidney Injury”

“…As mentioned earlier, AKI doubles the risk of chronic kidney disease [3], and conditions linked to reduced nephronic mass significantly contribute to AKI development [15].…”