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Etiology and outcome of acute kidney injury in children

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Abstract

The aim of this prospective, multicenter study was to define the etiology and clinical features of acute kidney injury (AKI) in a pediatric patient cohort and to determine prognostic factors. Pediatric-modified RIFLE (pRIFLE) criteria were used to classify AKI. The patient cohort comprised 472 pediatric patients (264 males, 208 females), of whom 32.6% were newborns (median age 3 days, range 1–24 days), and 67.4% were children aged >1 month (median 2.99 years, range 1 month–18 years). The most common medical conditions were prematurity (42.2%) and congenital heart disease (CHD, 11.7%) in newborns, and malignancy (12.9%) and CHD (12.3%) in children aged >1 month. Hypoxic/ischemic injury and sepsis were the leading causes of AKI in both age groups. Dialysis was performed in 30.3% of newborns and 33.6% of children aged >1 month. Mortality was higher in the newborns (42.6 vs. 27.9%; p < 0.005). Stepwise multiple regression analysis revealed the major independent risk factors to be mechanical ventilation [relative risk (RR) 17.31, 95% confidence interval (95% CI) 4.88–61.42], hypervolemia (RR 12.90, 95% CI 1.97–84.37), CHD (RR 9.85, 95% CI 2.08–46.60), and metabolic acidosis (RR 7.64, 95% CI 2.90–20.15) in newborns and mechanical ventilation (RR 8.73, 95% CI 3.95–19.29), hypoxia (RR 5.35, 95% CI 2.26–12.67), and intrinsic AKI (RR 4.91, 95% CI 2.04–11.78) in children  aged >1 month.

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Acknowledgments

Dr. Duzova is supported by The Turkish Academy of Sciences (Program to Reward Successful Young Scientists, A.D/TUBA-GEBIP/2006-6).

The authors would like to thank Hacettepe University Faculty of Medicine Research Office for their valuable assistance in statistical analysis.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Pediatric Nephrology and Rheumatology Unit, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, 06100, Turkey

    Ali Duzova & Aysin Bakkaloglu

  2. Department of Pediatric Nephrology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey

    Mukaddes Kalyoncu

  3. Department of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey

    Hakan Poyrazoglu

  4. Department of Pediatric Nephrology, Faculty of Medicine, Mersin University, Mersin, Turkey

    Ali Delibas

  5. Department of Pediatric Nephrology, Faculty of Medicine, 19 Mayis University, Samsun, Turkey

    Ozan Ozkaya

  6. Department of Pediatric Nephrology, Meram Faculty of Medicine, Selcuk University, Konya, Turkey

    Harun Peru

  7. Department of Pediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey

    Harika Alpay

  8. Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey

    Oguz Soylemezoglu

  9. Department of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey

    Ayfer Gur-Guven

  10. Department of Pediatric Nephrology, Behçet Uz Children’s Hospital, Izmir, Turkey

    Mustafa Bak

  11. Department of Pediatric Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey

    Zelal Bircan

  12. Department of Pediatric Nephrology, Baskent University Hospital, Adana, Turkey

    Nurcan Cengiz

  13. Department of Pediatric Nephrology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey

    Ipek Akil

  14. Department of Pediatric Nephrology, Faculty of Medicine, Ankara University, Ankara, Turkey

    Birsin Ozcakar

  15. Department of Pediatric Nephrology, Ministry of Health Diskapi Childrens Hospital, Ankara, Turkey

    Nermin Uncu

  16. Department of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey

    Aysun Karabay-Bayazit

  17. Department of Pediatric Nephrology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey

    Ferah Sonmez

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  1. Ali Duzova
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  2. Aysin Bakkaloglu
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  7. Harun Peru
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  9. Oguz Soylemezoglu
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  11. Mustafa Bak
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  14. Ipek Akil
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  15. Birsin Ozcakar
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  16. Nermin Uncu
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  18. Ferah Sonmez
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on behalf of The Turkish Society for Pediatric Nephrology Acute Kidney Injury Study Group

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Correspondence to Ali Duzova.

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Duzova, A., Bakkaloglu, A., Kalyoncu, M. et al. Etiology and outcome of acute kidney injury in children. Pediatr Nephrol 25, 1453–1461 (2010). https://doi.org/10.1007/s00467-010-1541-y

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  • DOI: https://doi.org/10.1007/s00467-010-1541-y

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