An assessment of acute kidney injury with modified RIFLE criteria in pediatric patients with severe burns

Palmieri, Tina L; Lavrentieva, Athina; Greenhalgh, David G.

doi:10.1007/s00134-009-1638-6

Cited by 91 publications

(99 citation statements)

References 23 publications

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“…Increased time of exposure to nephrotoxic medications, secondary to an increased length of stay, may increase the risk of developing AKI, and AKI has been independently associated with morbidity and mortality in various pediatric populations (3,8,13). However, confounding by indication may have influenced this result.…”

Section: Discussionmentioning

confidence: 99%

“…The pediatric modified Risk, Injury, Failure, Loss, End Stage (pRIFLE) criteria were used to determine AKI (13). Because urine output was not consistently available, eCCl was used for ascertainment of pRIFLE category (4,8,13,14). Cases were defined as patients who developed any degree of AKI as defined by pRIFLE criteria, and controls were defined as patients who did not develop AKI.…”

Section: Methodsmentioning

confidence: 99%

“…Importantly, nephrotoxic-medication exposure is becoming more prevalent as a primary cause of AKI, comprising approximately 16% of all pediatric inpatient causes of AKI (1,5,(7)(8)(9)(10). However, both the risk of developing AKI when any nephrotoxic medication is initiated and the additive risk of AKI development with multiple nephrotoxic medications are unknown.…”

Section: Introductionmentioning

confidence: 99%

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Acute Kidney Injury and Increasing Nephrotoxic-Medication Exposure in Noncritically-Ill Children

Moffett¹,

Goldstein²

2011

Clinical Journal of the American Society of Nephrology

191

145

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SummaryBackground and objectives Acute kidney injury (AKI) in hospitalized children results in increased patient morbidity and mortality. Nephrotoxic-medication exposure is a common cause of AKI. Currently, no data exist to quantify the risks of developing AKI for various nephrotoxic medications in children. The primary aim of the current study is to assess for a potential association between nephrotoxic medications and the risk of developing AKI in hospitalized noncritically ill children with no pre-existing renal insufficiency. Design, setting, participants, & measurementsWe performed a retrospective case-control study in pediatric hospitalized noncritically ill patients aged 1 day to 18 years. The cases were patients who developed AKI, as defined by the pediatric modified RIFLE (pRIFLE) criteria; patients without AKI served as controls and were matched by age category, gender, and disease state.Results 561/1660 (33.8%) patients identified for inclusion had AKI (441 category "R," 117 category "I," three category "F"); 357 cases were matched with 357 controls. Patients with AKI had longer length of hospital stay and increased hospital costs. Patients with AKI had exposure to more nephrotoxic medications for a longer period of time compared with controls. Odds of exposure for at least one nephrotoxic medication was significant for development of AKI. Exposure to more nephrotoxic medications was associated with an increased risk of AKI.Conclusions Increasing exposure to three or more nephrotoxic medications places pediatric patients at greater risk of acute kidney injury with resultant increased hospital costs and patient morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Acute Kidney Injury and Increasing Nephrotoxic-Medication Exposure in Noncritically-Ill Children

Moffett¹,

Goldstein²

2011

Clinical Journal of the American Society of Nephrology

191

145

View full text Add to dashboard Cite

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“…AKI was classified using a SCr-based categorical definition similar to Acute Kidney Injury Network (AKIN) (10) ( Table 1). The AKIN definition and the pediatric risk, injury, failure, loss and end-stage (pRIFLE) definition have been evaluated in several pediatric populations including those who required intensive care (1,2,11), received aminoglycosides (12), and required care in a pediatric burn unit (13). Using changes in SCr, these two definitions have been shown to have very close correlation in pediatrics (12).…”

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confidence: 99%

Acute Kidney Injury Reduces Survival in Very Low Birth Weight Infants

et al. 2011

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Acute kidney injury (AKI) independently predicts mortality in children and adults. Our understanding of the epidemiology of AKI in very LBW (VLBW) infants is limited to retrospective studies. After adjustment for demographics, comorbidities, and interventions, infants with AKI have decreased survival compared with those without AKI. The study was conducted in regional quaternary care NICU of the University of Alabama at Birmingham. VLBW infants were followed prospectively and were classified into a serum creatinine (SCr)-based classification for AKI. Forty-one of 229 (18%) VLBW infants developed AKI. Those with AKI were more likely to have umbilical artery catheters, assisted ventilation, blood pressure medications, and lower 1-and 5-min Apgar scores. Of the infants with AKI, 17 of 41 (42%) died compared with 9 of 188 (5%) of those without AKI (p Ͻ 0.001). AKI was associated with mortality with a crude hazard ratio (HR) of 9.3 (95% CI, 4.1-21.0). After adjusting for potential confounders, those with AKI had higher chance of death as the adjusted HR was 2.4 (95% CI 0.95-6.04). AKI is associated with mortality in VLBW infants. Efforts to prevent and ameliorate the impact of AKI may improve the outcomes in this vulnerable population. (Pediatr Res 69: 354-358, 2011)

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“…In 2004, the Acute Kidney Injury Network defined AKI based on time in relation to absolute creatinine increase, percentage increase, or documented oliguria. The adult-derived RIFLE definition was modified, applied, and validated in studies of critically ill patients (19) and renamed the pediatric RIFLE (pRIFLE) criteria (20). Recently the KDIGO workgroup has reviewed these criteria and published a single definition for use in both clinical practice and research.…”

Section: Discussionmentioning

confidence: 99%

Open Heart Surgery Associated Acute Kidney Injury in Children

Krastiņš

Straume

Auziņš

et al. 2013

Acta Chirurgica Latviensis

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Summary.Introduction. Cardiac surgery with cardiopulmonary bypass (CPB) is commonly perceived as a risk factor for decline in renal function. Hypothermia, hypoxia, hypotension, non-pulsatile blood flow during CPB, use of ACE inhibitors, inotropic and (or) vasoactive support affects kidney and contributes to the acute kidney injury (AKI). Aim of the study. The purpose of this study was to evaluate the incidence, severity and outcome of CPB related AKI in children after open heart surgery. Materials and methods. We conducted prospective, non-randomized observational study at the tertiary care University Children's Hospital Pediatric ICU. We enrolled 30 patients, 12 boys and 18 girls with congenital heart disease (CHD). Their median body weight was 6,8 kg, (IQR 5,2<8,2 kg) and median age 7 months (IQR 5<10 months). SCr was determined and preoperative and postoperative creatinine clearance (ClCr) was estimated using Schwarz formula (eClCr). During surgical repair and till the end of the first 12 postoperative hours urine was collected to measure ClCr, using the difference in urine (UCr) and SCr concentrations (mClCr). Urine output, body temperature, duration of aortic cross clamping and cardiopulmonary bypass was recorded. Results. Median intraoperative urine output was 2,4 ml/kg/h (IQR 1,29<3,15 ml/kg/h). Median CPB time was 147 min., (IQR 116,75<205 min.), median aortic cross-clamping time was 95 min., (IQR 70,5<133 min.), cooling during CPB to 29,75°C. Postoperative SCr increased to 35 μmol/l (IQR 27,5<50,5 μmol/l) vs. preoperative SCr 29 μmol/l (IQR 24<32,9 μmol/l), P<0,0001. GFR declined from preoperative 98,4 ml/min./1,73 m2 (IQR 89,6<123,04) to postoperative 80,98 ml/min./1,73 m2, (IQR 60,73<97,97 ml/min./1,73 m2), P<0,0001. We find statistically significant difference (P=0,042) in measured 39,88 ml/min./1,73 m2 (IQR 21,96<67,82 ml/min./1,73 m2) versus estimated ClCr (eClCr) 80,98 ml/min./1,73 m2, (IQR 60,73<97,97 ml/min./1,73 m2). Observed prevalence of AKI was 46,6% (14/30 patients met KDIGO criteria for AKI). Conclusions. Open heart surgery in children has severe, but transient effect on expression of renal biomarkers. There was a marked difference between measured and estimated ClCr in our patients. Observed incidence of AKI was 46,6% (14 patients met KDIGO criteria of AKI from 30 of our patients). Before discharge from the hospital both biomarkers returned to normal values.

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An assessment of acute kidney injury with modified RIFLE criteria in pediatric patients with severe burns

Cited by 91 publications

References 23 publications

Acute Kidney Injury and Increasing Nephrotoxic-Medication Exposure in Noncritically-Ill Children

Acute Kidney Injury and Increasing Nephrotoxic-Medication Exposure in Noncritically-Ill Children

Acute Kidney Injury Reduces Survival in Very Low Birth Weight Infants

Open Heart Surgery Associated Acute Kidney Injury in Children

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