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Incidence, Risk Factors, the Role of Plasma NGAL and Outcome of Contrast-Induced Acute Kidney Injury in Critically Ill Children

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Abstract

Objectives

To study the incidence of contrast-induced acute kidney injury (CI-AKI), evaluate its risk factors, study the role of plasma neutrophil gelatinase-associated lipocalin (NGAL) and evaluate the outcome of CI-AKI in critically ill children.

Methods

In this prospective cohort study, children aged 1 mo to 12 y who underwent contrast computed tomography (CECT) for various medical indications were included. Patients without renal function test before contrast administration, children with chronic kidney disease, children admitted for less than 48 h, and those with serum bilirubin more than 5 mg per dL were excluded. Serum creatinine and estimated-Glomerular filtration rate (e-GFR) were measured at admission, immediately before, and at 6, 24, 48 h after contrast. Plasma neutrophil gelatinase-associated lipocalin (NGAL) was measured before and 6 h after contrast. The incidence of CI-AKI by p-RIFLE (Pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease) criteria, its risk factors, the diagnostic role of NGAL in CI-AKI, and outcomes [30 d unfavorable outcome (death, readmission) and renal recovery] were studied.

Results

One hundred children were enrolled. The indications for CECT were brain (58%) and respiratory pathology (20%). Incidence of CI-AKI was 35% (95% CI 26.4% to 44.8%); 71% in ‘Risk,’ and 29% in the ‘Injury’ stage. After multivariate logistic regression, age younger than 2 y was independently associated with CI-AKI. There was no significant difference in NGAL before (ROC-AUC 0.38, 95% CI 0.26 to 0.50) and 6 h after CECT scan (AUC 0.41, 95% CI 0.29 to 0.54) to predict CI-AKI. There were 7% deaths but no readmission at 30 d. Among 33 CI-AKI patients who survived, the operational definition of renal recovery was achieved in 51.5% (n = 17), complete renal recovery was achieved in 97% (n = 32), and partial renal recovery was achieved in 3% (n = 1) of patients at discharge, while none received renal supportive therapy.

Conclusions

The incidence of contrast-induced acute kidney injury was 35% with age younger than two year being independently associated with CI-AKI. NGAL did not predict the CI-AKI.

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References

  1. Krishnamurthy S, Narayanan P, Prabha S, et al. Clinical profile of acute kidney injury in a pediatric intensive care unit from southern India: a prospective observational study. Indian J Crit Care Med. 2013;17:207–13.

    Article  Google Scholar 

  2. Sutherland SM, Byrnes JJ, Kothari M, et al. AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol. 2015;10:554–61.

    Article  Google Scholar 

  3. Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL; AWARE Investigators. Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med. 2017;376:11–20.

  4. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39:930–6.

    Article  Google Scholar 

  5. McDonald JS, McDonald RJ, Williamson EE, Kallmes DF, Kashani K. Post-contrast acute kidney injury in intensive care unit patients: a propensity score-adjusted study. Intensive Care Med. 2017;43:774–84.

    Article  Google Scholar 

  6. McDonald JS, McDonald RJ, Tran CL, Kolbe AB, Williamson EE, Kallmes DF. Postcontrast acute kidney injury in pediatric patients: a cohort study. Am J Kidney Dis. 2018;72:811–8.

    Article  Google Scholar 

  7. Cantais A, Hammouda Z, Mory O, et al. Incidence of contrast-induced acute kidney injury in a pediatric setting: a cohort study. Pediatr Nephrol. 2016;31:1355–62.

    Article  Google Scholar 

  8. Tkaczyk M, Tomczyk D, Jander A, et al. Glomerular filtration decrease after diagnostic cardiac catheterisation in children with congenital cardiac malformation - the role of serum creatinine, cystatin C, neutrophil gelatinase and urine output monitoring. Postepy Kardiol Interwencyjnej. 2018;14:67–74.

    PubMed  PubMed Central  Google Scholar 

  9. Spasojevic-Dimitrijeva B, Kotur-Stevuljevic J, Dukic M, et al. Serum neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule-1 as potential biomarkers of subclinical nephrotoxicity after gadolinium-based and iodinated-based contrast media exposure in pediatric patients with normal kidney function. Med Sci Monit. 2017;23:4299–305.

    Article  Google Scholar 

  10. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71:1028–35.

    Article  CAS  Google Scholar 

  11. Goldenberg I, Matetzky S. Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies. CMAJ. 2005;172:1461–71.

    Article  Google Scholar 

  12. Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin N Am. 1987;34:571–90.

    Article  CAS  Google Scholar 

  13. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–76.

    Article  Google Scholar 

  14. Schortgen F. Defining renal recovery: pitfalls to be avoided. Intensive Care Med. 2015;41:1993–5.

    Article  Google Scholar 

  15. Luo X, Jiang L, Du B, et al. A comparison of different diagnostic criteria of acute kidney injury in critically ill patients. Crit Care. 2014;18:R144.

    Article  Google Scholar 

  16. Zappitelli M, Parikh CR, Akcan-Arikan A, Washburn KK, Moffett BS, Goldstein SL. Ascertainment and epidemiology of acute kidney injury varies with definition interpretation. Clin J Am Soc Nephrol. 2008;3:948–54.

    Article  Google Scholar 

  17. Andreucci M, Solomon R, Tasanarong A. Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention. Biomed Res Int. 2014;2014:741018.

    PubMed  PubMed Central  Google Scholar 

  18. Nusca A, Miglionico M, Proscia C, et al. Early prediction of contrast-induced acute kidney injury by a "bedside" assessment of neutrophil gelatinase-associated lipocalin during elective percutaneous coronary interventions. PLoS One. 2018;13:e0197833.

  19. Devarajan P. Neutrophil gelatinase-associated lipocalin: a promising biomarker for human acute kidney injury. Biomark Med. 2010;4:265–80.

    Article  CAS  Google Scholar 

  20. Hwang YJ, Hyun MC, Choi BS, Chun SY, Cho MH. Acute kidney injury after using contrast during cardiac catheterization in children with heart disease. J Korean Med Sci. 2014;29:1102–7.

    Article  CAS  Google Scholar 

  21. Hirsch R, Dent C, Pfriem H, et al. NGAL is an early predictive biomarker of contrast-induced nephropathy in children. Pediatr Nephrol. 2007;22:2089–95.

    Article  Google Scholar 

  22. Ghani AA, Al Helal B, Hussain N. Acute renal failure in pediatric patients: etiology and predictors of outcome. Saudi J Kidney Dis Transpl. 2009;20:69–76.

    PubMed  Google Scholar 

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Acknowledgments

The JIPMER granted the support to attend and present the abstract in ESPNIC 2019 to RR and duly acknowledge the same. The authors acknowledge the contribution of Mrs. S. Raja Deepa B. Com, MCA (JIPMER Campus, Puducherry, India) for review and editing of the manuscript; Mr. Rakesh Mohindra (Punjab University, Chandigarh, India) and Mrs. Thenmozhi M (M.Sc, Ph.D., Senior Demonstrator, CMC, Vellore, India) for helping the statistical analysis and Mrs. Harpreet Kaur (Punjab University, Chandigarh, India), and Mrs. Neelima Chadha (Tulsi Das Library, PGIMER, Chandigarh, India) for helping medical literature search.

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Authors and Affiliations

  1. Division of Pediatric Critical Care, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India

    Yamini Agarwal & Ramachandran Rameshkumar

  2. Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India

    Sriram Krishnamurthy

  3. Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India

    Gandhipuram Periyasamy Senthilkumar

Authors
  1. Yamini Agarwal
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  2. Ramachandran Rameshkumar
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  3. Sriram Krishnamurthy
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  4. Gandhipuram Periyasamy Senthilkumar
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Contributions

YA and RR were involved in the management of the patients. YA collected the data, reviewed the literature, and drafted the first manuscript. SK contributed to protocol development, review of literature, and manuscript. GPS participated in protocol preparations and drafting of the manuscript and supervised the analysis of biochemical samples. RR conceptualized the study, reviewed the literature and critically reviewed the manuscript. All authors approved the final version of the manuscript. RR is the guarantor of the paper.

Corresponding author

Correspondence to Ramachandran Rameshkumar.

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None.

Source of Funding

JIPMER Intramural Research Grant (JIP/Res/Intr-MD/PHS2/2016–2017 dt 01.07.2017 and JIP/Res/Intramural/IInd yr grant/2017–2018 dt 13.09.2017 to RR). The JIPMER granted the support to attend and present the study abstract in the 30th Annual Meeting of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC 2019), 18–21, June 2019, Salzburg, Austria vide No.Admin.II/FV/2019 dt 06.06.2019 to RR.

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Note: The abstract was presented in the 30th Annual Meeting of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC 2019), held from 18 – 21 June 2019 at Salzburg, Austria.

Trial Registration: CTRI/2017/03/008060.

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Agarwal, Y., Rameshkumar, R., Krishnamurthy, S. et al. Incidence, Risk Factors, the Role of Plasma NGAL and Outcome of Contrast-Induced Acute Kidney Injury in Critically Ill Children. Indian J Pediatr 88, 34–40 (2021). https://doi.org/10.1007/s12098-020-03414-9

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  • DOI: https://doi.org/10.1007/s12098-020-03414-9

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