Abstract
Background: Acute kidney injury (AKI) due to urinary stone disease (USD) is rare in adults; AKI rates in children with USD may be higher, and emerging data links stones to chronic kidney disease (CKD) development in adults.Methods: This study is a retrospective analysis of USD patients at a single pediatric hospital system's emergency department (ED). Patients were initially identified by USD ICD codes; USD was then confirmed by imaging or physician documentation; patients had to have baseline creatinine (Cr) and Cr in the ED for comparison to be included. AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO), Acute Kidney Injury Network (AKIN), and Pediatric Risk, Injury, Failure, Loss, End Stage (pRIFLE).Results: Of the 589 total visits, 264/589 (45%) had data to evaluate for AKI, 23% were AKI(+) and 77% were AKI(–). pRIFLE was most common (82%) and 18% were only positive by AKIN/KDIGO. AKI(+) were more likely to be younger (16.7 vs. 17.4 years, p = 0.046) and more likely to present with vomiting {odds ratio [OR] [95% confidence interval (CI)]: 2.4 [1.4–4.3], p = 0.002}; also, the proportion of AKI(+) was significantly higher in <18 vs. ≥18 years [26.9 vs. 15.5%, p = 0.032, OR (95% CI): 2.0 (1.1–3.9)]. Urinary tract infection (UTI) and obstruction rates were similar between groups. AKI(+) patients had a significant OR <1 suggesting less risk of receiving non-steroidal anti-inflammatory drugs (NSAIDs); however, 51% of them did receive NSAIDs during their ED encounter. AKI(+) patients were more likely to require admission to the hospital (53 vs. 32%, p = 0.001).Conclusion: We have demonstrated a novel association between USD-induced renal colic and AKI in a group of young adults and children. AKI(+) patients were younger and were more likely to present with vomiting. AKI(+) patients did not have higher rates of obstruction or UTI, and 51% of AKI(+) received NSAIDs.
Highlights
Urinary stone disease (USD) is common in the United States, affecting 1 in 10 adults, and is becoming more common in the pediatric population [1]
While urinary stones are notorious for causing severe pain and renal colic, morbidity has traditionally been linked to urinary tract obstruction and/or infection [3]
Electronic medical records were reviewed for all patients under 25 years at a single freestanding pediatric hospital system identified by ICD coding from January 2008 to December 2017
Summary
Urinary stone disease (USD) is common in the United States, affecting 1 in 10 adults, and is becoming more common in the pediatric population [1]. Acute kidney injury (AKI) is defined by an abrupt decrease in renal function and has been strongly linked to increases in morbidity and mortality [4,5,6,7]. USD-associated AKI is most often attributed to the obstruction of a solitary kidney or both kidneys simultaneously and occurs in 1–2% of adult stone formers [8,9,10,11]. AKI in pediatric USD formers has not been well-described, but there is some evidence that children may be more susceptible with rates as high as 30% [12]. Acute kidney injury (AKI) due to urinary stone disease (USD) is rare in adults; AKI rates in children with USD may be higher, and emerging data links stones to chronic kidney disease (CKD) development in adults
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