The Indian Journal of Pediatrics

, Volume 84, Issue 6, pp 420–424 | Cite as

Incidence and Outcome of Acute Cardiorenal Syndrome in Hospitalized Children

  • Vivek Athwani
  • Maneesha Bhargava
  • Rahul Chanchlani
  • Amar Jeet Mehta
Original Article
  • 124 Downloads

Abstract

Objectives

To determine the incidence, etiology and outcome of Cardiorenal syndrome (CRS) in hospitalized children.

Methods

A prospective cohort study was carried out in 242 children between 6 mo to 18 y of age hospitalized with primary cardiac, renal or any systemic disorder at a tertiary care center in India. The primary outcome was the development of CRS. Univariate and multivariate logistic regression analysis were performed to determine the risk of mortality secondary to CRS.

Results

Among 242 children, 67 (27.7%) children developed CRS and the rest 175 (72.3%) did not. Among those with CRS, 40.3%, 20.9%, and 38.8% had CRS-1, 3 and 5, respectively. Cardiac diseases leading to CRS were myocarditis (40.7%) followed by congenital heart disease (25.9%), rheumatic heart disease (18.5%), and dilated cardiomyopathy (7.4%); renal disease associated with CRS was acute glomerulonephritis (100%) and major systemic disorders leading to CRS were septicemia (53.8%), malaria (23.1%), scrub typhus (7.7%), and acute gastroenteritis (3.8%). The occurrence of CRS was associated with an increased risk of mortality (OR 6.3, 95% CI: 2.8, 14.1; p 0.000). A subgroup analysis revealed that children with CRS having acute kidney injury stage 2 and 3 also had a higher risk of mortality (p 0.001).

Conclusions

The incidence of CRS is quite high in children with cardiac, renal or systemic diseases and is associated with a significant risk of mortality. Children presenting with these illnesses should be monitored for the occurrence of CRS so that early intervention may reduce mortality.

Keywords

Cardiorenal syndrome Acute kidney injury Acute decompensated heart failure 

References

  1. 1.
    Ronco C, McCullough P, Anker SD, et al. Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. Eur Heart J. 2010;31:703–11.CrossRefPubMedGoogle Scholar
  2. 2.
    Bongartz LG, Cramer MJ, Doevendans PA, Joles JA, Braam B. The severe cardiorenal syndrome: ‘Guyton revisited’. Eur Heart J. 2005;26:11–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52:1527–39.CrossRefPubMedGoogle Scholar
  4. 4.
    Price JF, Mott AR, Dickerson HA, et al. Worsening renal function in children hospitalized with decompensated heart failure: evidence for a pediatric cardiorenal syndrome? Pediatr Crit Care Med. 2008;9:279–84.CrossRefPubMedGoogle Scholar
  5. 5.
    Olowu WA, Adelusola KA. Pediatric acute renal failure in southwestern Nigeria. Kidney Int. 2004;66:1541–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Olowu WA. Acute childhood cardiorenal syndrome and impact of cardiovascular morbidity on survival. Int J Nephrol. 2011; doi:10.4061/2011/412495.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Bailey D, Phan V, Litalien C, et al. Risk factors of acute renal failure in critically ill children: a prospective descriptive epidemiological study. Pediatr Crit Care Med. 2007;8:29–35.CrossRefPubMedGoogle Scholar
  8. 8.
    Vachvanichsanong P, Dissaneewate P, Lim A, McNeil E. Childhood acute renal failure: 22-y experience in a university hospital in southern Thailand. Pediatrics. 2006;118:e786–91.CrossRefPubMedGoogle Scholar
  9. 9.
    Skippen PW, Krahn GE. Acute renal failure in children undergoing cardiopulmonary bypass. Crit Care Resusc. 2005;7:286–91.PubMedGoogle Scholar
  10. 10.
    Olowu WA. Systemic complications of acute glomerulonephritis in Nigerian children. Niger Postgrad Med J. 2002;9:83–7.PubMedGoogle Scholar
  11. 11.
    Olowu W. Childhood-onset systemic lupus erythematosus. J Natl Med Assoc. 2007;99:777–84.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Beger RD, Holland RD, Sun J, et al. Metabonomics of acute kidney injury in children after cardiac surgery. Pediatr Nephrol. 2008;23:977–84.CrossRefPubMedGoogle Scholar
  13. 13.
    Hsu DT, Pearson GD. Heart failure in children: part 1; history, aetiology and pathophysiology. Circ Heart Fail. 2009;2:63–70.CrossRefPubMedGoogle Scholar
  14. 14.
    Mehta RL, Kellum JA, Shah SV, et al. Acute kidney injury network: report of an initiative to improve outcome in acute kidney injury. Crit Care. 2007;11:R31.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Zaidi M, Rahman AJ, Haque A, Sadgani S, Maheshwari PM. Frequency of cardiorenal syndrome type-I in hospitalized children with acute heart failure in a tertiary-care hospital. J Coll Physicians Surg Pak. 2014;24:577–80.PubMedGoogle Scholar
  16. 16.
    Haase M, Müller C, Damman K, et al. Pathogenesis of cardiorenal syndrome type 1 in acute decompensated heart failure: workgroup statements from the eleventh consensus conference of the acute dialysis quality initiative (ADQI). Contrib Nephrol. 2013;182:99–116.CrossRefPubMedGoogle Scholar
  17. 17.
    Bagshaw SM, Hoste E, Braam B, et al. Cardiorenal syndrome type III: pathophysiologic and epidemiologic considerations. Contrib Nephrol. 2013;182:137–57.CrossRefPubMedGoogle Scholar
  18. 18.
    Chuasuwan A, Kellum JA. Cardiorenal syndrome type 3: epidemiology, pathophysiology, and treatment. Semin Nephrol. 2012;32:31–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Oh J, Wunsch R, Turzer M, et al. Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation. 2002;106:100–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Blinder JJ, Goldstein SL, Lee VV, et al. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg. 2012;143:368–74.CrossRefPubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2017

Authors and Affiliations

  • Vivek Athwani
    • 1
  • Maneesha Bhargava
    • 1
  • Rahul Chanchlani
    • 2
  • Amar Jeet Mehta
    • 1
  1. 1.Department of Pediatric Medicine, Division of Pediatric NephrologySMS Medical CollegeJaipurIndia
  2. 2.Division of Pediatric Nephrology, McMaster Children’s HospitalMcMaster UniversityHamiltonCanada

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