Skip to main content
SpringerLink
Log in

Prevalence of acute kidney injury during pediatric admissions for acute chest syndrome

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Patients with sickle cell disease are at risk for developing chronic kidney disease (CKD). Acute kidney injury (AKI) has been linked to progression to CKD, but limited data exist to determine its role in acute complications of sickle cell disease. We hypothesized that AKI occurs in pediatric patients admitted for acute chest syndrome (ACS) and prolongs hospitalization.

Methods

We conducted a 6-year retrospective review of pediatric patients with ACS admitted to a single medical institution.

Results

Of the 149 pediatric patients admitted for ACS during the 6-year study period, 12 (8 %) developed AKI. Comparison of patients with and without AKI revealed a significant association between AKI and a larger drop in hemoglobin value from baseline (2.7 vs. 1.4 g/dL; p = 0.003), a lower hemoglobin value at admission (6.4 vs. 7.5 g/dL; p = 0.03), and an increased white blood cell count at admission (33.1 vs. 19.8 × 109/L; p < 0.0001), respectively. AKI (p < 0.0001) together with need for advanced respiratory support (biphasic positive airway pressure or mechanical ventilation) (p < 0.0001) and need for exchange transfusion (p < 0.0001) were associated with prolonged hospitalization.

Conclusions

Clinicians should monitor pediatric patients hospitalized for ACS for the development of AKI as a potentially modifiable risk factor for prolonged hospitalization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hamideh D, Alvarez O (2013) Sickle cell disease related mortality in the United States (1999–2009). Pediatr Blood Cancer 60:1482–1486

    Article  PubMed  Google Scholar 

  2. Powars DR, Chan LS, Hiti A, Ramicone E, Johnson C (2005) Outcome of sickle cell anemia: a 4-decade observational study of 1056 patients. Medicine (Baltimore) 84:363–376

    Article  Google Scholar 

  3. Gosmanova EO, Zaidi S, Wan JY, Adams-Graves PE (2014) Prevalence and progression of chronic kidney disease in adult patients with sickle cell disease. J Investig Med 62:804–807

    Article  CAS  PubMed  Google Scholar 

  4. McClellan AC, Luthi JC, Lynch JR, Soucie JM, Kulkarni R, Guasch A, Huff ED, Gilbertson D, McClellan WM, DeBaun MR (2012) High one year mortality in adults with sickle cell disease and end-stage renal disease. Br J Haematol 159:360–367

    Article  PubMed  PubMed Central  Google Scholar 

  5. Powars DR, Elliott-Mills DD, Chan L, Niland J, Hiti AL, Opas LM, Johnson C (1991) Chronic renal failure in sickle cell disease: risk factors, clinical course, and mortality. Ann Intern Med 115:614–620

    Article  CAS  PubMed  Google Scholar 

  6. Lebensburger J, Johnson SM, Askenazi DJ, Rozario NL, Howard TH, Hilliard LM (2011) Protective role of hemoglobin and fetal hemoglobin in early kidney disease for children with sickle cell anemia. Am J Hematol 86:430–432

    Article  CAS  PubMed  Google Scholar 

  7. Miller ST, Wang WC, Iyer R, Rana S, Lane P, Ware RE, Li D, Rees RC, Investigators B-H (2010) Urine concentrating ability in infants with sickle cell disease: baseline data from the phase III trial of hydroxyurea (BABY HUG). Pediatr Blood Cancer 54:265–268

    PubMed  PubMed Central  Google Scholar 

  8. Wang WC, Ware RE, Miller ST, Iyer RV, Casella JF, Minniti CP, Rana S, Thornburg CD, Rogers ZR, Kalpatthi RV, Barredo JC, Brown RC, Sarnaik SA, Howard TH, Wynn LW, Kutlar A, Armstrong FD, Files BA, Goldsmith JC, Waclawiw MA, Huang X, Thompson BW, Investigators BH (2011) Hydroxycarbamide in very young children with sickle-cell anaemia: a multicentre, randomised, controlled trial (BABY HUG). Lancet 377:1663–1672

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Statius van Eps LW, Pinedo-Veels C, de Vries GH, de Koning J (1970) Nature of concentrating defect in sickle-cell nephropathy. Microradioangiographic studies. Lancet 1:450–452

    Article  CAS  PubMed  Google Scholar 

  10. Aygun B, Mortier NA, Smeltzer MP, Hankins JS, Ware RE (2011) Glomerular hyperfiltration and albuminuria in children with sickle cell anemia. Pediatr Nephrol 26:1285–1290

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chawla LS, Eggers PW, Star RA, Kimmel PL (2014) Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med 371:58–66

    Article  PubMed  Google Scholar 

  12. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C, Beginning, Ending Supportive Therapy for the Kidney I (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818

    Article  CAS  PubMed  Google Scholar 

  13. Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW (2005) Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 16:3365–3370

    Article  PubMed  Google Scholar 

  14. Chawla LS, Amdur RL, Amodeo S, Kimmel PL, Palant CE (2011) The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int 79:1361–1369

    Article  PubMed  PubMed Central  Google Scholar 

  15. Schneider J, Khemani R, Grushkin C, Bart R (2010) Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med 38:933–939

    Article  CAS  PubMed  Google Scholar 

  16. Audard V, Homs S, Habibi A, Galacteros F, Bartolucci P, Godeau B, Renaud B, Levy Y, Grimbert P, Lang P, Brun-Buisson C, Brochard L, Schortgen F, Maitre B, Mekontso Dessap A (2010) Acute kidney injury in sickle patients with painful crisis or acute chest syndrome and its relation to pulmonary hypertension. Nephrol Dial Transplant 25:2524–2529

    Article  PubMed  Google Scholar 

  17. Kidney Diseases: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group (2012). KDIGO clinical practice guidelines for acute kidney Injury. Kidney Int Suppl 2:1–138

  18. Miller ST (2011) How I treat acute chest syndrome in children with sickle cell disease. Blood 117:5297–5305

    Article  CAS  PubMed  Google Scholar 

  19. De Montalembert M, Abboud MR, Fiquet A, Inati A, Lebensburger JD, Kaddah N, Mokhtar G, Piga A, Halasa N, Inusa B, Rees DC, Heath PT, Telfer P, Driscoll C, Al Hajjar S, Tozzi A, Jiang Q, Emini EA, Gruber WC, Gurtman A, Scott DA (2015) 13-valent pneumococcal conjugate vaccine (PCV13) is immunogenic and safe in children 6–17 years of age with sickle cell disease previously vaccinated with 23-valent pneumococcal polysaccharide vaccine (PPSV23): results of a phase 3 study. Pediatr Blood Cancer 62:1427–1436

    Article  PubMed  Google Scholar 

  20. Meier ER, Wright EC, Miller JL (2014) Reticulocytosis and anemia are associated with an increased risk of death and stroke in the newborn cohort of the Cooperative Study of Sickle Cell Disease. Am J Hematol 89:904–906

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lebensburger JD, Miller ST, Howard TH, Casella JF, Brown RC, Lu M, Iyer RV, Sarnaik S, Rogers ZR, Wang WC, Investigators BH (2012) Influence of severity of anemia on clinical findings in infants with sickle cell anemia: analyses from the BABY HUG study. Pediatr Blood Cancer 59:675–678

    Article  PubMed  Google Scholar 

  22. Dowling MM, Quinn CT, Plumb P, Rogers ZR, Rollins NK, Koral K, Buchanan GR (2012) Acute silent cerebral ischemia and infarction during acute anemia in children with and without sickle cell disease. Blood 120:3891–3897

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Dowling MM, Quinn CT, Rogers ZR, Buchanan GR (2010) Acute silent cerebral infarction in children with sickle cell anemia. Pediatr Blood Cancer 54:461–464

    Article  PubMed  PubMed Central  Google Scholar 

  24. Cecchini J, Lionnet F, Djibre M, Parrot A, Stojanovic KS, Girot R, Fartoukh M (2014) Outcomes of adult patients with sickle cell disease admitted to the ICU: a case series*. Crit Care Med 42:1629–1639

    Article  PubMed  Google Scholar 

  25. Bernaudin F, Verlhac S, Arnaud C, Kamdem A, Vasile M, Kasbi F, Hau I, Madhi F, Fourmaux C, Biscardi S, Epaud R, Pondarre C (2015) Chronic and acute anemia and extracranial internal carotid stenosis are risk factors for silent cerebral infarcts in sickle cell anemia. Blood 125:1653–1661

    Article  CAS  PubMed  Google Scholar 

  26. Wierenga KJ, Serjeant BE, Serjeant GR (2001) Cerebrovascular complications and parvovirus infection in homozygous sickle cell disease. J Pediatr 139:438–442

    Article  CAS  PubMed  Google Scholar 

  27. Tracz MJ, Alam J, Nath KA (2007) Physiology and pathophysiology of heme: implications for kidney disease. J Am Soc Nephrol 18:414–420

    Article  CAS  PubMed  Google Scholar 

  28. Nath KA, Grande JP, Haggard JJ, Croatt AJ, Katusic ZS, Solovey A, Hebbel RP (2001) Oxidative stress and induction of heme oxygenase-1 in the kidney in sickle cell disease. Am J Pathol 158:893–903

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Aygun B, Mortier NA, Smeltzer MP, Shulkin BL, Hankins JS, Ware RE (2013) Hydroxyurea treatment decreases glomerular hyperfiltration in children with sickle cell anemia. Am J Hematol 88:116–119

    Article  CAS  PubMed  Google Scholar 

  30. dos Santos TE, Goncalves RP, Barbosa MC, da Silva GB, Daher EF Jr (2015) Monocyte chemoatractant protein-1: a potential biomarker of renal lesion and its relation with oxidative status in sickle cell disease. Blood Cells Mol Dis 54:297–301

    Article  PubMed  Google Scholar 

  31. Kilburn KH, Dowell AR (1971) Renal function in respiratory failure. Effects of hypoxia, hyperoxia, and hypercapnia. Arch Intern Med 127:754–762

    Article  CAS  PubMed  Google Scholar 

  32. Basu RK, Wheeler DS (2013) Kidney-lung cross-talk and acute kidney injury. Pediatr Nephrol 28:2239–2248

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

J.L would like to acknowledge the NIH (1K23HL127100-01) and American Society of Hematology Scholar Award for funding an ongoing cohort to study progression to CKD. The authors would like to thank the participants living with sickle cell disease as we strive to improve their care. The authors would also like to thank the additional members of the UAB Pediatric Sickle Cell team (Lee Hilliard, MD, Christina Bemrich-Stolz, MD, MSPH, Kristen Osborn CRNP, Susan Dobbins, CRNP, Heather Carlton, CRNP, Michelle McCall CRNP, and the SCD clinic nurses) for providing excellent care. The authors thank the UAB Pediatric Research office for their helpful resources and the Pediatric and Infant Center for Acute Nephrology.

Author information

Authors and Affiliations

  1. Pediatric Hematology Oncology, University of Alabama at Birmingham, 1600 7th Ave South, Lowder 512, Birmingham, AL, 35233, USA

    Jeffrey D. Lebensburger, Prasannalaxmi Palabindela & Thomas H. Howard

  2. Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA

    Daniel I. Feig & David J. Askenazi

  3. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA

    Inmaculada Aban

Authors
  1. Jeffrey D. Lebensburger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Prasannalaxmi Palabindela
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas H. Howard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel I. Feig
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Inmaculada Aban
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David J. Askenazi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeffrey D. Lebensburger.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to disclose

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lebensburger, J.D., Palabindela, P., Howard, T.H. et al. Prevalence of acute kidney injury during pediatric admissions for acute chest syndrome. Pediatr Nephrol 31, 1363–1368 (2016). https://doi.org/10.1007/s00467-016-3370-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-016-3370-0

Keywords

Search

Navigation