Acute kidney injury in pediatric non-traumatic rhabdomyolysis

Kuok, Chon In; Chan, Winnie Kwai Yu

doi:10.1007/s00467-021-05057-0

Cited by 6 publications

(7 citation statements)

References 25 publications

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“…Other than serum CK, myoglobin levels in blood and urine are also reliable parameters used in evaluating the severity of rhabdomyolysis and possess predictive value in diagnosing AKI. 21,23 However, because these parameters were not routinely measured in our practice, their characteristics in AKI could not be adequately evaluated in the present study.…”

Section: Discussionmentioning

confidence: 97%

“…The serum CK level reflects the severity of muscle damage and is a useful biomarker in determining AKI risk in both traumatic and nontraumatic conditions. 21,22 However, it is noteworthy that the initial CK level at presentation may not accurately represent the seriousness of injury. Serum CK continues to rise after muscle injury and usually peaks in 72 hours.…”

Section: Discussionmentioning

confidence: 99%

“…Concurring with other reviews, 9,20 our study demonstrated the association between the CK level and AKI. The serum CK level reflects the severity of muscle damage and is a useful biomarker in determining AKI risk in both traumatic and nontraumatic conditions 21,22 . However, it is noteworthy that the initial CK level at presentation may not accurately represent the seriousness of injury.…”

Section: Discussionmentioning

confidence: 99%

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Motor Vehicle Collision and Acute Kidney Injury in Children

Kuok

Chan

2022

Pediatr Emer Care

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ObjectiveOur study aimed to determine the prevalence of acute kidney injury (AKI) in pediatric patients who sustained trauma due to motor vehicle collision (MVC) and identify factors associated with its development.MethodsWe retrospectively reviewed the clinical information and laboratory tests of pediatric patients who were admitted because of MVC from January 2014 to April 2021. The occurrence of AKI was our primary outcome, which was defined by the Kidney Disease Improving Global Outcomes criteria. A serum creatine kinase (CK) level of 1000 IU/L or greater was defined as rhabdomyolysis.ResultsSixty-four patients (median age, 9.6 years) were included in the study. Twenty three of the patients (35.9%) developed AKI: stage 1 AKI in 18 (78.3%) and stage 2 AKI in 5 (21.7%) patients. Acute kidney injury patients had higher injury severity scores (no AKI: 5.0; stage 1 AKI: 10.5; stage 2 AKI: 26.0). Rhabdomyolysis was present in 21.1% of the patients and was associated with the overall AKI risk (odds ratio [OR], 7.3; 95% confidence interval [CI], 1.6–32.6) and stage 2 AKI (OR, 15.0; 95% CI, 1.4–163.2). Blood tests from AKI patients showed lower serum bicarbonate and base excess, higher leukocyte and CK levels on admission, and a higher peak CK in the first 72 hours of admission. Intubation in emergency department (OR, 11.1; 95% CI, 1.2–102.1) and surgical interventions (OR, 3.2; 95% CI, 1.0–9.8) were associated with AKI. Acute kidney injury patients required longer stay in pediatric intensive care unit (median 1.0 vs 2.3 days, P < 0.001) and hospital (median 4.1 vs 7.0 days, P = 0.010).ConclusionsApproximately one third of pediatric patients who sustained trauma from MVC developed AKI. Initial blood results, including higher CK and leukocyte count, and lower bicarbonate and base excess, were associated with the development of AKI. Rhabdomyolysis occurred in approximately one fifth of the patients and was significantly associated with AKI.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Motor Vehicle Collision and Acute Kidney Injury in Children

Kuok

Chan

2022

Pediatr Emer Care

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“…Our study showed that urine dipstick tests for heme and protein can be utilized as a quick and noninvasive method to determine the risk of AKI development, which was also evident in other clinical scenarios. 24 25 Expansion of the use of these tests in family clinics and emergency departments may further expedite the detection of high-risk patients so that hospital admission and treatment can be arranged at earlier stages.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury and Hemolytic Uremic Syndrome in Severe Pneumococcal Pneumonia—A Retrospective Analysis in Pediatric Intensive Care Unit

Kuok

Hsu

Lai

et al. 2022

J Pediatr Intensive Care

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Objectives: This study aimed to evaluate the prevalence of acute kidney injury (AKI) and hemolytic uremic syndrome (HUS) in severe pediatric pneumonia due to Streptococcus pneumoniae and to identify factors associated with AKI and HUS in these patients. Methods: We retrospectively analyzed pediatric patients who were admitted to our pediatric intensive care unit due to severe pneumococcal pneumonia between 2013 and 2019. Results: Forty-two patients with a median age of 4.3 years were included. Among these patients, 14 (33.3%) developed AKI, including seven (16.7%) stage 1, two (4.8%) stage 2, and five (11.9%) stage 3 AKI. Features of HUS were present in all of the patients with stage 3 AKI, and four required renal replacement therapy (RRT), with a median duration of 10.5 days (range 3 to 16 days). All patients with HUS required mechanical ventilation and inotropic supports. Patients with lower leukocyte and platelet counts, serum sodium and bicarbonate levels, positive urine dipstick (heme or protein ≥ 2 + ), and presence of bacteremia were associated with stage 2 and 3 AKI. Conclusions: Pediatricians should be aware of the relatively high prevalence of kidney involvement in severe pneumococcal pneumonia, with one-third having AKI and 11.9% developing HUS. Majority (80%) of HUS patients required RRT. Positive urine dipstick, serum sodium, and bicarbonate at presentation, which can be measured in point-of-care tests, may potentially be useful as quick tests to stratify the risks of moderate-to-severe AKI.

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“…The mechanism of RML involves muscle cell lysis with strong likelihood of blood electrolyte disorders, including hyperkalaemia, hyperphosphatemia, hyperuricaemia, hyperanionic interstitial metabolic acidosis and hypermagnesemia, accentuated when renal failure is present (15). The incidence of AKI in children with RML is approximately 5-35% (16)(17)(18). GBS is rarely complicated by renal function impairment.…”

Section: Acute Kidney Injury (Aki)mentioning

confidence: 99%

Guillain-Barré syndrome (GBS) complicated by rhabdomyolysis (RML): Case reports of 2 children and literature review

Yang

Tong²,

Lv³

2022

Front. Pediatr.

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We initially described two children who developed Guillain-Barré syndrome (GBS) complicated by rhabdomyolysis (RML), and reviewed five adult patients from the literature. Through analysis of the clinical features, laboratory examination, treatment and prognostic data from these seven patients, we found that when GBS “meets” RML, the most prominent characteristics were the following: male dominance; limb weakness, pain and respiratory failure could be caused by multiple factors; limb weakness and respiratory muscle paralysis were more serious than with GBS alone; and the probability of mechanical ventilation was increased. Neuroelectrophysiological studies revealed axonal lesions. Close monitoring and timely identification and intervention to remedy potentially fatal complications such as electrolyte disorder multisystem complications and kidney injury are crucial. With plasma exchange, peritoneal dialysis and supportive treatment, the long-term outcome of most patients was satisfactory.

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Acute kidney injury in pediatric non-traumatic rhabdomyolysis

Cited by 6 publications

References 25 publications

Motor Vehicle Collision and Acute Kidney Injury in Children

Motor Vehicle Collision and Acute Kidney Injury in Children

Acute Kidney Injury and Hemolytic Uremic Syndrome in Severe Pneumococcal Pneumonia—A Retrospective Analysis in Pediatric Intensive Care Unit

Guillain-Barré syndrome (GBS) complicated by rhabdomyolysis (RML): Case reports of 2 children and literature review

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