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Increasing frequency of acute kidney injury amongst children hospitalized with nephrotic syndrome

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Abstract

Background

Nephrotic syndrome (NS) is among the most common kidney diseases seen in children. The major complications of NS include infection, acute kidney injury (AKI), and thromboembolism (TE). The objective of this study was to analyze long-term trends in the epidemiology of major complications of pediatric NS.

Methods

We used the Healthcare Cost and Utilization Project Kids’ Inpatient Database for the years 2000–2009 to perform an analysis of U.S. hospitalizations of children diagnosed with NS with or without infection, AKI or TE.

Results

The frequency of NS hospitalizations complicated by AKI increased by 158 % between 2000 and 2009 (p < 0.001). The frequency of NS hospitalizations with infection and TE remained stable overall. Pneumonia was the most common infectious complication while peritonitis decreased by 50 % (p < 0.001). Importantly, development of any of these major complications of NS resulted in ∼2–3-fold increases in both hospital charges and length of stay.

Conclusions

It is concerning that the frequency of AKI in children hospitalized with NS has more than doubled in the past decade. Strategies to prevent or initiate earlier treatments for complications of NS could have a major impact on both morbidity and health care expenses.

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Abbreviations

NS:

Nephrotic syndrome

AKI:

Acute kidney injury

TE:

Thromboembolism

HCUP:

Healthcare Cost and Utilization Project

KID:

Kids’ Inpatient Database

LOS:

Length of stay

ATN:

Acute tubular necrosis

RRT:

Renal replacement therapy

FSGS:

Focal segmental glomerulosclerosis

PCV7:

Seven-valent pneumococcal conjugate vaccine

PCV13:

Thirteen-valent pneumococcal conjugate vaccine

CNI:

Calcineurin Inhibitor

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Acknowledgments

We would like to acknowledge the HCUP data partners who have contributed to HCUP (www.hcup-us.ahrq.gov/hcupdatapartners.jsp)

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Authors and Affiliations

  1. University of Minnesota Amplatz Children’s Hospital, Minneapolis, MN, USA

    Michelle N. Rheault

  2. Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan

    Chang-Ching Wei

  3. Center for Clinical and Translational Research, The Research Institute at Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, 43205, USA

    David S. Hains, Wei Wang, Bryce A. Kerlin & William E. Smoyer

Authors
  1. Michelle N. Rheault
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  2. Chang-Ching Wei
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  3. David S. Hains
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  4. Wei Wang
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  6. William E. Smoyer
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Corresponding author

Correspondence to William E. Smoyer.

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Rheault, M.N., Wei, CC., Hains, D.S. et al. Increasing frequency of acute kidney injury amongst children hospitalized with nephrotic syndrome. Pediatr Nephrol 29, 139–147 (2014). https://doi.org/10.1007/s00467-013-2607-4

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  • DOI: https://doi.org/10.1007/s00467-013-2607-4

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