Community‐acquired Acute Kidney Injury Among Children Seen in the Pediatric Emergency Department

Bernardo, Erika; Cruz, Andrea T.; Buffone, Gregory J.; Devaraj, Sridevi; Loftis, Laura; Akcan-Arikan, Ayse

doi:10.1111/acem.13421

Cited by 23 publications

(24 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a single-center study of pediatric emergency department visits over 1 year at a large academic center, the incidence of community-acquired AKI was 1.5%. This study also showed that only 19% of these episodes were recognized by the treating physician [76]. Each of these studies argues for improved recognition and surveillance in general pediatric populations.…”

Section: General Pediatric and Specific Populationsmentioning

confidence: 73%

An Update on Neonatal and Pediatric Acute Kidney Injury

2018

View full text Add to dashboard Cite

Purpose of Review The purpose of this review is to highlight the major advances of pediatric and neonatal acute kidney injury (AKI) research over the last 5 years with particular interest in describing renal physiology, the definition of AKI, risk factors, epidemiology, interventions, and outcomes. Recent Findings The utilization of standardized definitions of AKI has revolutionized our understanding of the incidence and impact of AKI. This has culminated in the seminal Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology in critically ill children (AWARE), and Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) publications in pediatric and neonatal AKI, respectively. These studies have clearly shown an independent association of AKI with mortality in critically ill children and neonates. Recent work aimed at the prevention of AKI has demonstrated that nephrotoxic medication-induced AKI occurs commonly and can be prevented with protocolized renal function monitoring. This review also highlights advances in the early identification of patients at risk for the development of AKI via scoring systems (renal angina index), functional tests (furosemide stress test), or novel biomarkers. Furthermore, fluid overload has clearly been shown to impact outcomes in those with the most severe forms of AKI requiring renal replacement therapy. Recent single-center studies have highlighted that children with AKI are at increased risk of chronic kidney disease. Conclusions The incidence and adverse impact of AKI on outcomes across critically ill pediatric and neonatal populations have been clearly established The importance of fluid overload in children with severe AKI requiring renal replacement therapy is clear. Children with AKI are at increased risk of chronic kidney disease and require long-term outpatient follow-up. As the impact of AKI has become clear, efforts have shifted to prevention of nephrotoxic-induced AKI, early identification, risk stratification (renal angina), and the development of novel biomarkers.

show abstract

Section: General Pediatric and Specific Populationsmentioning

confidence: 73%

An Update on Neonatal and Pediatric Acute Kidney Injury

2018

View full text Add to dashboard Cite

show abstract

“…The only dialysis patient died from lack of timely availability of resources. In addition, patients have to pay out-of-pocket hospital bills in a primary care facility before transferring them to dialysis in a tertiary hospital and also have to pay a deposit as a risk if they cannot pay for the services at the end of that hospital [21][22] .…”

Section: Discussionmentioning

confidence: 99%

Outcome and Incidence of Acute Kidney Injury among Hospitalized Children

Masood¹,

Farrukh²,

Rizvi³

et al. 2021

PJMHS

View full text Add to dashboard Cite

Background and purpose: Data on the epidemiology of acute kidney injury (ARI) in Asia come primarily from studies conducted in large tertiary hospitals with nephrology departments. Little is known about what happens in primary care settings without nephrology, especially in the paediatric population. The aim of this study is to describe the epidemiology, outcome and risk factors of ARF in children admitted in pediatric department. Place and Duration: In the Pediatric Medicine and Nephrology department of Abbasi Shaheed Hospital for one-year duration from August 2020 to August 2021. Methods: We prospectively examined children aged 2 to 14 whose guardians gave the consent for the study and were admitted in the Pediatric ward. We identified children with risk factors for AKI on admission and then tested them for AKI using the 2012 Creatinine-based Modified General Kidney Disease Improvement (KDIGO) criteria to improve overall outcomes. Participants with AKI were followed up to discharge. The subject of interest was the need and access to dialysis and renal recovery on discharge from the hospital. Results: A total of 74.3% (n = 116) out of the 156 patients admitted during the study period were at risk of ARF. Of the 156 registered participants, 51.9% (n = 81) were males with a mean age of 5 years. Although comorbid conditions were rare, sickle cell anaemia and malnutrition were the most common. Most of the children were hypotensive (n = 89; 57.1%), with mean systolic and diastolic blood pressures of 81 mmHg and 42 mmHg, respectively. The mean urine output was 0.79 ml / kg / hr. Thirteen patients (8.33%) had urine dipstick anomalies. Anaemia was common (n = 72, 46.2%) and 32 (20.5%) had severe anaemia. Leucocytosis was detected in 26.3% of patients, and a platelet count below 100,000 / mm3 in 24 (15.4%) patients. In total, 21 of 156 participants had AKI for an incidence of 13.5%. The only patient with an indication for dialysis (uremic encephalopathy and anuria> 24 hours) died without dialysis due to a delay in transfer to a dialysis centre (due to lack of resources). Of the 20 survivors in the AKI group, 15 (71.4%) had complete improvement in kidney function The median hospitalization time was significantly longer in participants with stage 3 AKI. Conclusions: ARF risk factors are very common in children admitted in the hospitals. At least one in 10 children presenting with AKI risk factors will have AKI. AKI is largely caused by community-acquired diseases that can be prevented, such as diarrheal diseases and malaria. Efforts should be made to educate about risk assessment, prevention, early diagnosis and treatment of AKI in children. Keywords: AKI; epidemiology; risk factors and outcome.

show abstract

“…2 Another factor to consider is the high incidence of AKI in hospitalised patients in areas with more resources, in contrast to community-acquired AKI and patients in rural areas, where AKI is often not detected. [28][29][30][31] Nonetheless, AKI in this population is often avoidable and reversible, affecting healthy and young individuals, and might be secondary to animal venoms, complications during pregnancy including septic abortion, use of herbal medicine, infectious diarrhoea, and other infectious diseases (Table 1).…”

Section: Acute Dialysis Quality Initiative Recommendations For Diagnosis Of Aki Inmentioning

confidence: 99%

Acute Kidney Injury: Risk Factors and Management Challenges in Low- and Middle-Income Countries

et al. 2020

View full text Add to dashboard Cite

Acute kidney injury (AKI) is a major global health problem, occurring in >13 million people and responsible for >2.3 million deaths every year, 85% of which are in developing countries. Although the International Society of Nephrology (ISN) set a goal of eliminating preventable deaths by AKI by 2025, implementation of this program in developing countries presents major challenges for several reasons: there are few data on the epidemiology and causes of AKI in low- and middle-income countries (LMIC); health care resources to diagnose, manage, and treat AKI are often limited; and governments, institutions, and global health initiatives have not focussed sufficiently on the AKI problems. Thus, developing and implementing effective strategies to eliminate preventable deaths from AKI in LMIC have required efforts to better understand how to increase the awareness of AKI by health care workers and institutions.

show abstract

Community‐acquired Acute Kidney Injury Among Children Seen in the Pediatric Emergency Department

Abstract: CA-AKI remains an underrecognized entity in the PED. Better tools for early recognition of AKI in the busy PED environment are needed.

Cited by 23 publications

References 43 publications

An Update on Neonatal and Pediatric Acute Kidney Injury

An Update on Neonatal and Pediatric Acute Kidney Injury

Outcome and Incidence of Acute Kidney Injury among Hospitalized Children

Acute Kidney Injury: Risk Factors and Management Challenges in Low- and Middle-Income Countries

Contact Info

Product

Resources

About