Frequency of Drug Induced Acute Kidney Injury in Pediatric Intensive Care Unit

Abstract

Background: Acute kidney injury (AKI) is known to complicate one-third of cases in pediatric intensive care units (PICU), and almost one-fourth of these are due to nephrotoxic drugs (NTDs). Although stopping NTDs seems the most obvious option, it is not practically applicable. Many NTDs are the only existing option, and their potential benefits outweigh the risk of drug-induced AKI. Objectives: To assess the proportion of children receiving NTDs in the PICU and highlight the children who developed AKI. Methods: A prospective observational study was conducted in the PICU of the National Institute of Child Health, Karachi. All children admitted to the PICU for at least 72 hours not diagnosed with any acute or chronic kidney disease were included. Serum creatinine (SCr) was done at admission and then after 72 hours. Data was entered and analyzed using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. Results: Of 99 children, 53 (53.5%) were male. NTD exposure was positive in 97 (97.9%), and 72 (72.7%) had high exposure (≥3 NTDs). Drug-induced AKI was diagnosed in 46 (46.5%). It was significantly related to high SCr even at admission and high NTDs exposure. The mortality rate in the AKI group was 17% compared to 4% in the non-AKI (p=0.02). Conclusion: Almost half of all PICU admissions were infants. Almost all patients were exposed to NTDs, and three-fourth experienced high exposure. AKI developed in 46% of patients and may be predicted by raised creatinine at the time of admission. Children exposed to ≥3 NTDs had a higher chance of drug-induced AKI.

Outcomes of COVID-19 patients with acute kidney injury and longitudinal analysis of laboratory markers during the hospital stay: A multi-center retrospective cohort experience from Pakistan

“…Furthermore, these in-hospital events can be attributed to the disease course, development of cytokine release storm, [ 33 ] or drug-induced renal injury related to COVID-19 therapy. [ 34 ] Despite this aspect could not be covered by our analysis, concomitant liver injury influencing AKI is another contributory event that can be attributed to multi-organ failure associated with COVID-19. The same findings were reproduced by a large single-center Iranian cohort.…”

Comparative Analysis of Intensive Care Prognosis Scoring Systems and Acute Kidney Injury Scores (AKIN and pRIFLE) in Critically Ill Children

“…It has been reported that the development of kidney injury is related to medications in approximately 25% of critically ill children [ 17 , 18 , 19 ]. Gowa et al’s [ 20 ] study, which included 99 children in a PICU, reported that 97.9% of the patients were exposed to nephrotoxic drugs, and 46.5% of the patients developed drug-induced AKI. In our study, the rates of medications that are common in PICUs were found to be significantly higher in patients with AKI.…”

Integrative analysis of renal microRNA and mRNA to identify hub genes and pivotal pathways associated with cyclosporine-induced acute kidney injury in mice

“…3 Importantly, drugs are also a frequent cause of AKI in the pediatric intensive care unit. 4 Cyclosporin (CsA) is a dominant immunosuppressive drug utilized to prevent rejection following organ transplantation. 5 Despite its positive effect, the side effects of the CsA cannot be overlooked.…”