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Etiology and outcomes of acute kidney disease in children: a cohort study

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Abstract

Background

There is paucity of information regarding the etiology and outcomes of Acute Kidney Disease (AKD) in children.

Methods

The objectives of this cohort study were to evaluate the etiology and outcomes of AKD; and analyze predictors of kidney survival (defined as free of CKD 2, 3a, 3b, 4 or 5). Patients aged 1 month to 18 years who developed AKD over a 4-year-period (January 2018-December 2021) were enrolled. Survivors were followed-up at the pediatric nephrology clinic, and screened for residual kidney injury.

Results

Among 5710 children who developed AKI, 200 who developed AKD were enrolled. The median (IQR) eGFR was 17.03 (10.98, 28) mL/min/1.73 m2. Acute glomerulonephritis, acute tubular necrosis (ATN), hemolytic uremic syndrome (HUS), sepsis-associated AKD, and snake envenomation comprised of 69 (34.5%), 39 (19.5%), 24 (12%), 23 (11.5%) and 15 (7.5%) of the patients respectively. Overall, 88 (44%) children required kidney replacement therapy (KRT). There were 37 (18.5%) deaths within the AKD period. At a follow-up of 90 days, 32 (16%) progressed to chronic kidney disease stage-G2 or greater. At a median (IQR) follow-up of 24 (6, 36.5) months (n = 154), 27 (17.5%) had subnormal eGFR, and 20 (12.9%) had persistent proteinuria and/or hypertension. Requirement of KRT predicted kidney survival (free of CKD 2, 3a, 3b, 4 or 5) in AKD (HR 6.7, 95% CI 1.2, 46.4) (p 0.04).

Conclusions

Acute glomerulonephritis, ATN, HUS, sepsis-associated AKD and snake envenomation were common causes of AKD. Mortality in AKD was 18.5%, and 16% progressed to CKD-G2 or greater at 90-day follow-up.

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Availability of data and materials

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable. Data subsets are available with the corresponding author.

References

  1. Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM, Acute Disease Quality Initiative Workgroup 16, et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol. 2017;13:241–57.

    Article  PubMed  Google Scholar 

  2. Gameiro J, Carreiro C, Fonseca JA, Pereira M, Jorge S, Gouveia L, et al. Acute kidney disease and long-term outcomes in critically ill acute kidney injury patients with sepsis: a cohort analysis. Clin Kidney J. 2020;14:1379–87.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Esposito P, Avella A, Ferrari F, Bruno G, Libetta C, Battaglia Y, et al. Renal outcomes of dialysis-dependent acute kidney injury in noncritically ill patients: a retrospective study. Blood Purif. 2022;51:390–6.

    Article  CAS  PubMed  Google Scholar 

  4. Chen YW, Wu MY, Mao CH, Yeh YT, Chen TT, Liao CT, et al. Severe acute kidney disease is associated with worse kidney outcome among acute kidney injury patients. Sci Rep. 2022;12:6492.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Yang M, Li Y, Li P, Fan Y, Zhang Y, Yuan R, et al. The effect of long-term duration renal replacement therapy on outcomes of critically ill patients with acute kidney injury: a retrospective cohort study. Evid Based Complement Alternat Med. 2021;2021:6623667.

    PubMed  PubMed Central  Google Scholar 

  6. Thakar CV, Yared JP, Worley S, Cotman K, Paganini EP. Renal dysfunction and serious infections after open-heart surgery. Kidney Int. 2003;64:239–46.

    Article  PubMed  Google Scholar 

  7. Liaño F, Junco E, Pascual J, Madero R, Verde E. The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. Kidney Int Suppl. 1998;66:S16-24.

    PubMed  Google Scholar 

  8. Woodrow G, Turney JH. Cause of death in acute renal failure. Nephrol Dial Transplant. 1992;7:230–4.

    Article  CAS  PubMed  Google Scholar 

  9. Girling BJ, Channon SW, Haines RW, Prowle JR. Acute kidney injury and adverse outcomes of critical illness: correlation or causation? Clin Kidney J. 2019;13:133–41.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Joannidis M, Forni LG, Klein SJ, Honore PM, Kashani K, Ostermann M, et al. Lung-kidney interactions in critically ill patients: consensus report of the acute disease quality initiative (ADQI) 21 workgroup. Intensive Care Med. 2020;46:654–72.

    Article  PubMed  Google Scholar 

  11. Rangaswami J, Bhalla V, Blair JEA, Chang TI, Costa S, Lentine KL, et al. Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: a scientific statement from the American heart association. Circulation. 2019;139:e840-78.

    Article  PubMed  Google Scholar 

  12. Tanaka S, Okusa MD. Crosstalk between the nervous system and the kidney. Kidney Int. 2020;97:466–76.

    Article  PubMed  Google Scholar 

  13. See EJ, Polkinghorne KR, Toussaint ND, Bailey M, Johnson DW, Bellomo R, et al. Epidemiology and outcomes of acute kidney diseases: a comparative Analysis. Am J Nephrol. 2021;52:342–50.

    Article  PubMed  Google Scholar 

  14. Patel M, Heipertz A, Joyce E, Kellum JA, Horvat C, Squires JE, et al. Acute kidney disease predicts chronic kidney disease in pediatric non-kidney solid organ transplant patients. Pediatr Transplant. 2021;26:e14172.

    PubMed  PubMed Central  Google Scholar 

  15. Frisby-Zedan J, Barhight MF, Keswani M, Arzu J, Nelson D. Long-term kidney outcomes in children following continuous kidney replacement therapy. Pediatr Nephrol. 2022. https://doi.org/10.1007/s00467-022-05579-1.

    Article  PubMed  Google Scholar 

  16. LoBasso M, Schneider J, Sanchez-Pinto LN, Del Castillo S, Kim G, Flynn A, et al. Acute kidney injury and kidney recovery after cardiopulmonary bypass in children. Pediatr Nephrol. 2022;37:659–65.

    Article  PubMed  Google Scholar 

  17. Deng YH, Yan P, Zhang NY, Luo XQ, Wang XF, Duan SB. Acute kidney disease in hospitalized pediatric patients with acute kidney injury in China. Front Pediatr. 2022;10: 885055.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Schwartz GJ, Haycock GB, Edelmann CM, Spitzer A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics. 1976;58:259–63.

    Article  CAS  PubMed  Google Scholar 

  19. Vijayakumar M. Acute and crescentic glomerulonephritis. Indian J Pediatr. 2002;69:1071–5.

    Article  CAS  PubMed  Google Scholar 

  20. Bagga A, Khandelwal P, Mishra K, Thergaonkar R, Vasudevan A, Sharma J, Indian Society of Pediatric Nephrology, et al. Hemolytic uremic syndrome in a developing country: consensus guidelines. Pediatr Nephrol. 2019;34:1465–82.

    Article  PubMed  Google Scholar 

  21. Levin A, et al. Kidney disease: improving global outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.

    Google Scholar 

  22. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Huang Y, Yang X, Zhang Y, Yue S, Mei X, Bi L, et al. Correlation of urine protein/creatinine ratios to 24-h urinary protein for quantitating proteinuria in children. Pediatr Nephrol. 2020;35:463–8.

    Article  PubMed  Google Scholar 

  24. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140: e20171904.

    Article  PubMed  Google Scholar 

  25. van der Watt G, Omar F, Brink A, McCulloch M. Laboratory investigation of the child with suspected renal disease. In: Avner ED, Harmon WE, Niaudet P, Yoshikawa N, Emma F, Goldstein SL, editors. Pediatric nephrology. 7th ed. Berlin: Springer-Verlag Berlin and Heidelberg GmbH & Co.KG; 2016. p. 616.

  26. Askenazi DJ, Feig DI, Graham NM, Hui-Stickle S, Goldstein SL. 3–5-year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int. 2006;69:184–9.

    Article  CAS  PubMed  Google Scholar 

  27. Greenberg JH, Coca S, Parikh CR. Long-term risk of chronic kidney disease and mortality in children after acute kidney injury: a systematic review. BMC Nephrol. 2014;15:184.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hoffmeister PA, Hingorani SR, Storer BE, Baker KS, Sanders JE. Hypertension in long-term survivors of pediatric hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2010;16:515–24.

    Article  CAS  PubMed  Google Scholar 

  29. Levey AS. Defining AKD: the spectrum of AKI, AKD and CKD. Nephron. 2021;24:1–4.

    Google Scholar 

  30. Krishnamurthy S, Mondal N, Narayanan P, Biswal N, Srinivasan S, Soundravally R. Incidence and etiology of acute kidney injury of acute injury in southern India. Indian J Pediatr. 2013;80:183–9.

    Article  PubMed  Google Scholar 

  31. Mammen C, Al Abbas A, Skippen P, Nadel H, Levine D, Collet JP, et al. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis. 2012;59:523–30.

    Article  PubMed  Google Scholar 

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Funding

This work was supported by an intramural grant from Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, which is gratefully acknowledged.

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Authors and Affiliations

  1. Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India

    Amar Murdeshwar, Sriram Krishnamurthy, Narayanan Parameswaran, Bobbity Deepthi, Sudarsan Krishnasamy & Pediredla Karunakar

  2. Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India

    Medha Rajappa

  3. Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India

    Sachit Ganapathy

Authors
  1. Amar Murdeshwar
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  2. Sriram Krishnamurthy
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  8. Pediredla Karunakar
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Contributions

AM, SK, NP, BD, SuK and PK managed the patients. AM participated in study protocol preparations, recruited patients, participated in data analysis and drafted the first version of the manuscript. SK conceptualised the study design, collected the data, interpreted the data and critically revised the manuscript. MR interpreted the biochemical laboratory reports. NP, BD, SuK and PK assisted in recruitment of the patients, data analysis and drafting the manuscript. SG helped in statistical analysis. All authors contributed to protocol preparation, drafting of the manuscript, and approved the final version of the manuscript. SK shall act as the corresponding author and guarantor of the paper.

Corresponding author

Correspondence to Sriram Krishnamurthy.

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The authors have no competing interests to declare that are relevant to the content of this article. The authors have no financial or proprietary interests in any material discussed in this article.

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Approved by the Ethics Committee of the institute (IEC/2020/124).

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Murdeshwar, A., Krishnamurthy, S., Parameswaran, N. et al. Etiology and outcomes of acute kidney disease in children: a cohort study. Clin Exp Nephrol 27, 548–556 (2023). https://doi.org/10.1007/s10157-023-02339-9

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  • DOI: https://doi.org/10.1007/s10157-023-02339-9

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