Acute Kidney Injury in Pediatric Heart Failure

Riley, Alyssa A.; Gebhard, Daniel; Akcan-Arikan, Ayse

doi:10.2174/1573403x12666151119165628

Cited by 13 publications

(7 citation statements)

References 107 publications

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“…In our study, though, only one patient presented AKI with a nephrotic syndrome relapse. Cardiovascular diseases, such as heart failure and congenital heart disease, also impose a significant risk for AKI 28 . AKI is particularly common in children undergoing cardiac surgery, with studies suggesting a significant correlation between moderate to severe forms of injury and postoperative mortality 29 , which is in line with our findings.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology

Figueiredo,

Rocha,

Silva

et al. 2024

Braz. J. Nephrol.

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Introduction: Acute kidney injury (AKI) is an abrupt deterioration of kidney function. The incidence of pediatric AKI is increasing worldwide, both in critically and non-critically ill settings. We aimed to characterize the presentation, etiology, evolution, and outcome of AKI in pediatric patients admitted to a tertiary care center. Methods: We performed a retrospective observational single-center study of patients aged 29 days to 17 years and 365 days admitted to our Pediatric Nephrology Unit from January 2012 to December 2021, with the diagnosis of AKI. AKI severity was categorized according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The outcomes considered were death or sequelae (proteinuria, hypertension, or changes in renal function at 3 to 6 months follow-up assessments). Results: Forty-six patients with a median age of 13.0 (3.5–15.5) years were included. About half of the patients (n = 24, 52.2%) had an identifiable risk factor for the development of AKI. Thirteen patients (28.3%) were anuric, and all of those were categorized as AKI KDIGO stage 3 (p < 0.001). Almost one quarter (n = 10, 21.7%) of patients required renal replacement therapy. Approximately 60% of patients (n = 26) had at least one sequelae, with proteinuria being the most common (n = 15, 38.5%; median (P25–75) urinary protein-to-creatinine ratio 0.30 (0.27–0.44) mg/mg), followed by reduced glomerular filtration rate (GFR) (n = 11, 27.5%; median (P25–75) GFR 75 (62–83) mL/min/1.73 m2). Conclusions: Pediatric AKI is associated with substantial morbidity, with potential for proteinuria development and renal function impairment and a relevant impact on long-term prognosis.

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Section: Discussionmentioning

confidence: 99%

Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology

Figueiredo,

Rocha,

Silva

et al. 2024

Braz. J. Nephrol.

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“…Renal dysfunction can lead to the accumulation of metabolic waste products and electrolyte imbalances, which can cause systemic inflammations and organ dysfunction, contributing to or failures in multiple systems [23][24][25]. Additionally, renal disease may serve as a marker of overall disease severity or susceptibility to other risk factors for MODS, as supported by multiple literatures [26][27][28][29][30][31][32][33].…”

Section: Plos Onementioning

confidence: 94%

Traditional herbal medicine use doubled the risk of multi-organ dysfunction syndrome in children: A prospective cohort study

Teshager,

Amare,

Tamirat

et al. 2024

PLoS ONE

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Background Traditional herbal medicine (THM) is frequently used in pediatric populations in many low-income countries as a form of healthcare and has been associated with a range of adverse events, including liver toxicity, renal failure, and allergic reactions. Despite these concerns, its impact on multi-organ dysfunction syndrome (MODS) risk has not been thoroughly investigated. Objective This study aimed to investigate the incidence and predictors of MODS in a pediatric intensive care unit (PICU) in Ethiopia, with a focus on the association between THM use and the risk of MODS. Methods This was a single-center prospective cohort study conducted at a PICU in the university of Gondar Comprehensive Specialized hospital, Northwest Ethiopia. The study enrolled eligible patients aged one month to 18 years admitted to the PICU during the study period. Data on demographic characteristics, medical history, clinical and laboratory data, and outcome measures using standard case record forms, physical examination, and patient document reviews. The predictors of MODS were assessed using Cox proportional hazards models, with a focus on the association between traditional herbal medicine use and the risk of MODS. Results A total of 310 patients were included in the final analysis, with a median age of 48 months and a male-to-female ratio of 1.5:1. The proportion and incidence of MODS were 30.96% (95% CI:25.8, 36.6) and 7.71(95% CI: 6.10, 9.40) per 100-person-day observation respectively. Renal failure (17.74%), neurologic failure (15.16%), and heart failure (14.52%) were the leading organ failures identified. Nearly one-third of patients (32.9%) died in the PICU, of which 59.8% had MODS. The rate of mortality was higher in patients with MODS than in those without. The Cox proportional hazards model identified renal disease (AHR = 6.32 (95%CI: 3.17,12.61)), intake of traditional herbal medication (AHR = 2.45, 95% CI:1.29,4.65), modified Pediatric Index of Mortality 2 (mPIM 2) score (AHR = 1.54 (95% CI: 1.38,1.71), and critical illness diagnoses (AHR = 2.68 (95% CI: 1.77,4.07)) as predictors of MODS. Conclusion The incidence of MODS was high. Renal disease, THM use, mPIM 2 scores, and critical illness diagnoses were independent predictors of MODS. A more than twofold increase in the risk of MODS was seen in patients who used TMH. Healthcare providers should be aware of risks associated with THM, and educate caregivers about the potential harms of these products. Future studies with larger sample sizes and more comprehensive outcome measures are needed.

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“…No entanto, em nosso estudo, apenas um paciente apresentou IRA com uma recidiva de síndrome nefrótica. As doenças cardiovasculares, como insuficiência cardíaca e cardiopatias congênitas, também impõem um risco significativo de IRA 28 . A IRA é particularmente comum em crianças submetidas a cirurgia cardíaca, com estudos sugerindo uma correlação significativa entre formas moderadas a graves de lesão e mortalidade pós-operatória 29 , o que está em conformidade com nossos achados.…”

Section: Tabelaunclassified

Insuficiência renal aguda: experiência de um centro terciário de Nefrologia Pediátrica

Figueiredo,

Rocha,

Silva

et al. 2024

Braz. J. Nephrol.

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RESUMO Introdução: Insuficiência renal aguda (IRA) é uma deterioração abrupta da função renal. A incidência de IRA pediátrica está aumentando em todo o mundo, em ambientes críticos e não críticos. Nosso objetivo foi caracterizar apresentação, etiologia, evolução e desfechos da IRA em pacientes pediátricos internados em um centro de atendimento terciário. Métodos: Realizamos estudo retrospectivo observacional de centro único de pacientes com idade entre 29 dias a 17 anos e 365 dias internados em nossa Unidade de Nefrologia Pediátrica, de janeiro de 2012 a dezembro de 2021, com diagnóstico de IRA. A gravidade da IRA foi categorizada de acordo com os critérios do Kidney Disease Improving Global Outcomes (KDIGO). Os desfechos considerados foram óbito ou sequelas (proteinúria, hipertensão ou alterações na função renal em avaliações de acompanhamento de 3 a 6 meses). Resultados: Incluímos 46 pacientes com idade mediana de 13,0 (3,5–15,5) anos. Cerca de metade (n = 24; 52,2%) apresentou um fator de risco identificável para o desenvolvimento de IRA. Treze pacientes (28,3%) eram anúricos; todos foram classificados como IRA KDIGO 3 (p < 0,001). Quase um quarto (n = 10; 21,7%) dos pacientes necessitaram de terapia renal substitutiva. Aproximadamente 60% (n = 26) apresentou pelo menos uma sequela, sendo proteinúria a mais comum (n = 15; 38,5%; mediana (P25–75) da relação proteína/creatinina urinária 0,30 (0,27–0,44) mg/mg), seguida de taxa de filtração glomerular (TFG) reduzida (n = 11; 27,5%; mediana (P25–75) da TFG 75 (62–83) mL/min/1,73 m2). Conclusões: A IRA pediátrica está associada à morbidade substancial, com potencial para desenvolvimento de proteinúria e comprometimento da função renal e impacto relevante no prognóstico de longo prazo.

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Acute Kidney Injury in Pediatric Heart Failure

Cited by 13 publications

References 107 publications

Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology

Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology

Traditional herbal medicine use doubled the risk of multi-organ dysfunction syndrome in children: A prospective cohort study

Insuficiência renal aguda: experiência de um centro terciário de Nefrologia Pediátrica

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