Acute Kidney Injury In Children Research Articles

Expression of SIRT6 and VNN1 in children with primary nephrotic syndrome and their correlation with acute kidney injury.

To explore the diagnostic and prognostic values of Sirtuin 6 (SIRT6) and Vanin-1 (VNN1) in peripheral blood monocytes of children with primary nephrotic syndrome (PNS) and their correlation with acute kidney injury (AKI). A retrospective analysis was conducted on 101 children (observation group) diagnosed with PNS and treated at the Shanxi University of Traditional Chinese Medicine Affiliated Hospital from December 2021 to December 2023. These children were categorized into two groups: the AKI group (n=35) and the non-AKI group (n=66), based on the presence of AKI. Additionally, 101 healthy children who underwent physical examinations during the same period served as the control group. Western blotting and RT-PCR were employed to measure the protein and mRNA levels of SIRT6 and VNN1 in monocytes across the three groups. The correlation between SIRT6 and VNN1 mRNA levels and clinical data, as well as kidney function indicators, was analyzed. The diagnostic value of SIRT6 and VNN1 mRNA levels for AKI in PNS was assessed using ROC curves. Multivariate logistic regression identified independent factors influencing AKI in PNS. The mRNA levels of SIRT6 and VNN1 were also compared before and after treatment in children with PNS. The AKI group exhibited lower SIRT6 protein and mRNA levels, and higher VNN1 protein and mRNA levels in monocytes compared to the other groups (all P<0.05). Correlation analysis revealed that SIRT6 mRNA levels were positively correlated with serum creatinine (Scr), uric acid (UA), blood urea nitrogen (BUN), 24-hour urine protein (24h UP), cystatin C (Cys-C), and β2-microglobulin (β2-MG), but negatively correlated with albumin (ALB) and estimated glomerular filtration rate (eGFR) (all P<0.05). In contrast, VNN1 levels showed the opposite correlations (P<0.05). ROC curve analysis showed that the AUC for SIRT6 or VNN1 mRNA alone in diagnosing AKI was above 0.8, with a combined diagnostic AUC exceeding 0.9. Logistic regression indicated that eGFR, β2-MG, Cys-C, and the mRNA levels of SIRT6 and VNN1 were independent risk factors for AKI in PNS (all P<0.05). After treatment, SIRT6 mRNA levels significantly decreased, while VNN1 mRNA levels increased in children with PNS (both P<0.05). SIRT6 and VNN1 are closely associated with AKI in children with PNS and may serve as valuable biomarkers for the diagnosis of AKI.

The problem of the diagnosis of acute kidney injury in children operated under the conditions of artificial circulation

Acute kidney injury (AKI) associated with cardiac surgery in children is one of the most frequent complications of the postoperative period appearing due to various perioperative factors. Generally accepted criteria for the diagnosis of AKI, on the one hand, may underestimate the frequency of development of this complication, on the other hand, require verification for use in the pediatric population. The application of kidney injury markers in pediatric practice is associated with a number of difficulties. For example, the high variability of the concentration of markers depending on age complicates the interpretation of the result, and maternal molecules can circulate in the blood of newborns. At the same time, in the cardiac surgery practice, the greatest impact of the measurement of kidney injury markers in children has been noted, which allows significantly accelerate the diagnosis of this complication and the starting of its therapy.

Pediatric acute kidney injury – Prevalence, clinical spectrum and outcome in a tertiary care institute of Eastern India

In this study, we wanted to determine the incidence and prevalence of AKI in admitted patients of our institution in relation to their age, sex and clinical conditions. We also wanted to study the various aetiologies causing acute kidney injury in children, its severity in admitted patients, the time interval of onset of disease and onset of AKI, it’s mode of management and outcomes in children.This study was conducted in the paediatric ward of a tertiary care hospital in Eastern India. Total 147 cases of hospitalized AKI patients were studied.The incidence of AKI was found to be 1.27% in all hospitalized children. Maximum no. of cases were found in the age group &amp;#62;10 years (44.2%). Male children outnumbered female children by a ratio of 2:1. Fever (72.8%) and Oliguria/anuria (72.1%) were the most common presenting features. Pallor was the most common presenting sign in 66% followed by oedema (42.2%), encephalopathy (31.9%) and respiratory distress (16.3%). 32% of cases presented within 24hrs with an H/O oliguria/anuria and 64% in within 72hrs. Most patients were managed with conservative management (53%) but 36.7% were managed with HD and 10.3% were managed with PD.Acute Kidney Injury cases were more common in children of age group &amp;#62;10 years, males being affected more. Fever and oliguria/anuria were the commonest mode of presentations with malaria as the most frequent clinical condition associated with AKI followed by sepsis. The renal type was the commonest type of AKI. There was a moderate derangement of kidney function in the majority of cases with hyperkalaemia in a significant group of patients. 47% of patients required dialytic support and case fatality was 13%. The presence of dysnatremia, hyperkalaemia, encephalopathy and shock were poor predictors of the outcome of AKI.

Incidence of Antimicrobial-Associated Acute Kidney Injury in Children: A Structured Review.

Acute kidney injury (AKI) is a commonly reported adverse effect of administration of antimicrobials. While AKI can be associated with poorer outcomes, there is little information available to understand rates of AKI in children exposed to various antimicrobials. We performed a structured review using the PubMed and Embase databases. Articles were included if they provided an AKI definition in patients who were <19 years of age receiving an antimicrobial and reported the frequency of AKI. Author-defined AKI rates were calculated for each study and mean pooled estimates for each antimicrobial were derived from among all study participants. Pooled estimates were also derived for those studies that reported AKI according to pRIFLE(pediatric risk, injury, failure, loss, end stage criteria), AKIN(acute kidney injury network), or KDIGO (kidney disease improving global outcomes)creatinine criteria. A total of 122 studies evaluating 28 antimicrobials met the inclusion criteria. Vancomycin was the most commonly studied drug: 11,514 courses across 44 included studies. Among the 27,285 antimicrobial exposures, the overall AKI rate was 13.2% (range 0-42.1% by drug), but the rate of AKI varied widely across studies (range 0-68.8%). Cidofovir (42.1%) and conventional amphotericin B (37.0%) had the highest pooled rates of author-defined AKI. Eighty-one studies used pRIFLE, AKIN, or KDIGO AKI criteria and the pooled rates of AKI were similar to author-defined AKI rates. In conclusion, antimicrobial-associated AKI is reported to occur frequently in children, but the rates of AKI varies widely across studies and drugs. Most published studies examined hospitalized patients and heterogeneity in study populations and in author definitions of AKI are barriers to a comparison of nephrotoxicity risk among antimicrobials in children.

Incidence and risk factors for acute kidney injury in children with congenital heart disease undergoing cardiac surgery in a tertiary care center.

Objective: To determine the incidence and risk factors associated with acute kidney injury (AKI) in children with congenital heart diseases (CHDs) who underwent cardiac surgery in a tertiary care center. Study Design: Cross-sectional study. Setting: Paediatric Cardiac Intensive Care Unit (PCICU) of National Institute of Cardiovascular diseases, Karachi, Pakistan. Period: November 2022 to May 2023. Material &amp; Methods: We included patients of both genders and any age who underwent open or closed heart surgery for congenital heart defects. All patients undergoing CHD repairs were monitored for the total duration of PCICU stay. The development of AKI was labeled as per RIFLE criteria, and management thereafter was performed as per standard institutional protocols. Results: In a total of 93 patients with CHD, there were 50 (53.8%) males and 43 (46.2%) females. The mean age was 9.71±9.14 year ranging between 3 months to 60 years. There were 6 (6.5%) patients who developed AKI post-surgery. Overall, mortality was noted in 7 (7.5%) patients. Cardiopulmonary bypass (CPB) time and aortic cross-clamp (ACC) time were significantly higher among patients who developed post-surgery AKI (&lt;0.001). Moreover, post-surgery AKI was significantly associated with intra-operative hypotension (p&lt;0.001), post-operative hypotension (p&lt;0.001), and post-operative sepsis (p&lt;0.001). It was also found that AKI had significant association with higher post-operative inotropic scores (p&lt;0.001), prolonged duration of mechanical ventilation (p&lt;0.001), and length of PCICU stay (p&lt;0.001). Mortality had significant association with AKI (33.3% vs. 5.7%, p=0.013). Conclusion: We noted the incidence of AKI among patient who underwent cardiac repairs to be 6.5%. CPB time and ACC time were significantly higher among patients who developed post-surgery AKI. Post-surgery AKI was significantly associated with intra-operative hypotension, post-operative hypotension, and post-operative sepsis. Mortality was significant high among cases that had AKI.

External validation of the modified sepsis renal angina index for prediction of severe acute kidney injury in children with septic shock

BackgroundAcute kidney injury (AKI) occurs commonly in pediatric septic shock and increases morbidity and mortality. Early identification of high-risk patients can facilitate targeted intervention to improve outcomes. We previously modified the renal angina index (RAI), a validated AKI prediction tool, to improve specificity in this population (sRAI). Here, we prospectively assess sRAI performance in a separate cohort.MethodsA secondary analysis of a prospective, multicenter, observational study of children with septic shock admitted to the pediatric intensive care unit from 1/2019 to 12/2022. The primary outcome was severe AKI (≥ KDIGO Stage 2) on Day 3 (D3 severe AKI), and we compared predictive performance of the sRAI (calculated on Day 1) to the original RAI and serum creatinine elevation above baseline (D1 SCr > Baseline +). Original renal angina fulfillment (RAI +) was defined as RAI ≥ 8; sepsis renal angina fulfillment (sRAI +) was defined as RAI ≥ 20 or RAI 8 to < 20 with platelets < 150 × 103/µL.ResultsAmong 363 patients, 79 (22%) developed D3 severe AKI. One hundred forty (39%) were sRAI + , 195 (54%) RAI + , and 253 (70%) D1 SCr > Baseline + . Compared to sRAI-, sRAI + had higher risk of D3 severe AKI (RR 8.9, 95%CI 5–16, p < 0.001), kidney replacement therapy (KRT) (RR 18, 95%CI 6.6–49, p < 0.001), and mortality (RR 2.5, 95%CI 1.2–5.5, p = 0.013). sRAI predicted D3 severe AKI with an AUROC of 0.86 (95%CI 0.82–0.90), with greater specificity (74%) than D1 SCr > Baseline (36%) and RAI + (58%). On multivariable regression, sRAI + retained associations with D3 severe AKI (aOR 4.5, 95%CI 2.0–10.2, p < 0.001) and need for KRT (aOR 5.6, 95%CI 1.5–21.5, p = 0.01).ConclusionsPrediction of severe AKI in pediatric septic shock is important to improve outcomes, allocate resources, and inform enrollment in clinical trials examining potential disease-modifying therapies. The sRAI affords more accurate and specific prediction than context-free SCr elevation or the original RAI in this population.

The impact of tubular dysfunction and its relationship with acute kidney injury in children.

Tubular dysfunction can cause electrolyte disturbances with potentially serious consequences. We studied the epidemiology and outcomes of electrolyte disturbances and tubular dysfunction among critically ill children and evaluated their relationships with acute kidney injury (AKI). We conducted a prospective cohort study recruiting children aged 1month to ≤ 18years old admitted to the pediatric intensive care unit (PICU) from 6/2020 to 6/2021. The serum levels of sodium, potassium, calcium, phosphate, and magnesium were reviewed and simultaneous urinary investigations for tubular function were performed among children with electrolyte disturbances. Altogether there were 253 episodes of admission. The median (interquartile) age was 4.9 (1.3-11.0) years and 58.1% were male. The median number of electrolyte disorders was 3 (2-4) types. Hypophosphatemia (74.2%), hypocalcemia (70.3%) and hypermagnesemia (52.9%) were the three commonest types of disturbances. Urinary electrolyte wasting was commonly observed among children with hypomagnesemia (70.6%), hypophosphatemia (67.4%) and hypokalemia (28.6%). Tubular dysfunction was detected in 82.6% of patients and urinary β2-microglobulin level significantly correlated with the severity of tubular dysfunction (p < 0.001). The development of tubular dysfunction was independent of AKI status. Tubular dysfunction was associated with mortality (p < 0.001) and was an independent predictor of PICU length of stay (LOS) (p < 0.001). The incorporation of the tubular dysfunction severity into the AKI staging system improved the prediction of PICU LOS. Tubular dysfunction was associated with both morbidity and mortality in critically ill children and its assessment may help to capture a more comprehensive picture of acute kidney insult.

Kidney outcomes in Shiga toxin-associated hemolytic uremic syndrome in childhood: A retrospective single-center study from 1999 to 2017: Kidney outcomes in typical hemolytic uremic syndrome in childhood

BackgroundShiga toxin-associated hemolytic uremic syndrome (STECHUS) is the main cause of acute kidney injury in children and may be responsible for adverse outcomes despite an apparent quiescent period. ObjectiveTo describe the medium- and long-term kidney outcomes of pediatric STECHUS in a French region. MethodsA single-center, descriptive, retrospective study of STECHUS cases that occurred at Besançon University Hospital between 1999 and 2017 in children up to 17 years of age was conducted. The primary study endpoint was the proportion of chronic kidney disease (CKD) cases at 5 years of follow-up. ResultsWe included 98 consecutive patients. Among the 71 patients at the 5-year follow-up, we found 24 (34 %) patients with no adverse kidney outcome, 18 (25 %) with moderate adverse kidney outcome, and one (1.4 %) with severe adverse kidney outcome. Among the 96 patients at 1 year from the diagnosis, these figures were, respectively, 25 (26 %), 51 (53 %), and two (2 %); and among the 38 patients at 10 years, they were, respectively, nine (24 %), 12 (32 %), and one (3 %). The glomerular filtration rate level and oliguria–anuria beyond 8 days at baseline were significantly associated with more severe kidney outcomes at 10 years (p = 0.03 and 0.005, respectively). Two patients died during the acute phase. Overall, 33 patients (34 %) were lost to follow-up. ConclusionAdverse kidney outcomes may appear many years after an episode of STECHUS despite an apparent quiescent period. Regular long-term monitoring is required. The challenge is to reduce the proportion of patients lost to follow-up with potentially severe adverse kidney outcomes and no evaluation or treatment.

Risk factors of acute kidney injury in pediatric acute lymphoblastic leukemia with hyperleukocytosis ymphoblastic Leukemia

Background Acute kidney injury (AKI) can be found in pediatric acute lymphoblastic leukemia (ALL) patients with hyperleukocytosis. Acute kidney Injury (AKI) increases hospital length of stay and mortality. Previous studies have only reported the AKI incidence in ALL patients with hyperleukocytosis, without clarifying risk factors attributed to AKI incidence.&#x0D; Objective To determine the risk factors of AKI in pediatric ALL patients with hyperleukocytosis.&#x0D; Methods A case-control study was conducted in children aged 1-18 years admitted to Dr. Sardjito Hospital (RSUP Dr. Sardjito), Yogyakarta, Central Java Total population sampling of pediatric ALL patients with hyperleukocytosis and AKI was used for the case group, and a simple random sampling ratio of 1:2 was used for the control group. Cut-off values for each independent variable were determined by receiver-operator characteristic (ROC) curves. Bivariate and multivariate analyses were performed on potential risk factors.&#x0D; Results Fourteen pediatric ALL patients with hyperleukocytosis and AKI were included in the case group and 28 children with ALL and hyperleukocytosis but without AKI were included in the control group. The incidence of AKI in children with ALL and hyperleukocytosis was 15.4%. Multivariate analysis revealed that the significant risk factors of AKI in ALL patients with hyperleukocytosis were phosphate concentration ?5.15 mg/L (OR 10.43; 95%CI 1.38 to 79.04; P=0.02) and uric acid concentration ?9.08 mg/dL (OR 12.39; 95%CI 1.88 to 81.44; P=0.009).&#x0D; Conclusion Phosphate concentration ?5.15 mg/L and uric acid ?9.08 mg/dL were risk factors of AKI in pediatric ALL patients with hyperleukocytosis.

Shiga Toxin-Producing Escherichia Coli Associated Hemolytic Uremic Syndrome

Shiga toxin-producing Escherichia coli (STEC)-associated hemolytic uremic syndrome (STEC-HUS) is a clinical syndrome involving hemolytic anemia (with fragmented red blood cells), low levels of platelets in the blood (thrombocytopenia), and acute kidney injury (AKI). It is the major infectious cause of AKI in children. Severe forms can be associated with multiorgan involvement during the acute stage of the disease. Endothelial injury is the trigger event in the microangiopathic process. The host inflammatory response to toxin and E. coli lipopolysaccharide (LPS) is involved in disease pathophysiology. Early diagnosis and identification of underlying pathogenic mechanisms are of great significance for improving prognosis and reducing sequelae and mortality. Typical management of STEC-HUS patients relies on supportive care for electrolyte and water imbalance, anemia, hypertension, and renal failure. At present there is no specific therapy to ameliorate the prognosis. The Immediate outcome is most often favorable but long-term renal sequelae are frequent due to nephron loss. This review summarizes current knowledge regarding the epidemiological findings, the pathophysiological and clinical aspects, and its diagnosis and management.

Epidemiology of acute kidney injury in children: a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference

The nephrology and critical care communities have seen an increase in studies exploring acute kidney injury (AKI) epidemiology in children. As a result, we now know that AKI is highly prevalent in critically ill neonates, children, and young adults. Furthermore, children who develop AKI experience greater morbidity and higher mortality. Yet knowledge gaps still exist that suggest a more comprehensive understanding of AKI will form the foundation for future efforts designed to improve outcomes. In particular, the areas of community acquired AKI, AKI in non-critically ill children, and cohorts from low-middle income countries have not been well studied. Longer-term functional outcomes and patient-centric metrics including social determinants of health, quality of life, and healthcare utilization should be the foci of the next phase of scholarship. Current definitions identify AKI-based upon evidence of dysfunction which serves as a proxy for injury; biomarkers capable of identifying injury as it occurs are likely to more accurately define populations with AKI. Despite the strength of the association, the causal and mechanistic relationships between AKI and poorer outcomes remain inadequately examined. A more robust understanding of the relationship represents a potential to identify therapeutic targets. Once established, a more comprehensive understanding of AKI epidemiology in children will allow investigation of preventive, therapeutic, and quality improvement interventions more effectively.

The renal vascular resistive index as a predictor of acute kidney injury in children of the first year of life in congenital heart surgery with cardiopulmonary bypass

The objective was to evaluate the renal vascular resistive index as a predictor of acute kidney injury in children of the first year of life in congenital heart surgery with cardiopulmonary bypass. Materials and methods. A single-center retrospective study included 150 patients with congenital heart disease (CHD), whose renal vascular resistive index (RVRI) was assessed at the stages of surgical interventions (before surgery, 6 hours after the end of cardiopulmonary bypass (CPB) and the 1st day after surgery). Acute kidney injury (AKI) was diagnosed according to the KDIGO criteria. To achieve comparability of the obtained groups, pseudo-randomization was performed. After compensating for the uneven distribution of cofounders, groups of patients comparable in number were obtained (n= 52 in both groups). Results. The renal vascular resistive index at the stages of surgical intervention did not differ among patients with and without acute kidney injury. The baseline of creatinine was higher in the group without AKI, however, starting from the 1st postoperative day, it prevailed in the group with AKI. The chances of developing AKI in male patients were 74% lower. Conclusion. The absence of a predictive ability of the renal vascular resistive index in acute kidney injury in children aged 1 month to 1 year with congenital heart disease operated with cardiopulmonary bypass was demonstrated.

Shiga toxin targets the podocyte causing hemolytic uremic syndrome through endothelial complement activation

Shiga toxin (Stx)-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS) is the leading cause of acute kidney injury in children, with an associated mortality of up to 5%. The mechanisms underlying STEC-HUS and why the glomerular microvasculature is so susceptible to injury following systemic Stx infection are unclear. Transgenic mice were engineered to express the Stx receptor (Gb3) exclusively in their kidney podocytes (Pod-Gb3) and challenged with systemic Stx. Human glomerular cell models and kidney biopsies from patients with STEC-HUS were also studied. Stx-challenged Pod-Gb3 mice developed STEC-HUS. This was mediated by a reduction in podocyte vascular endothelial growth factor A (VEGF-A), which led to loss of glomerular endothelial cell (GEnC) glycocalyx, a reduction in GEnC inhibitory complement factor H binding, and local activation of the complement pathway. Early therapeutic inhibition of the terminal complement pathway with a C5 inhibitor rescued this podocyte-driven, Stx-induced HUS phenotype. This study potentially explains why systemic Stx exposure targets the glomerulus and supports the early use of terminal complement pathway inhibition in this devastating disease. This work was supported by the UK Medical Research Council (MRC) (grant nos. G0901987 and MR/K010492/1) and Kidney Research UK (grant nos. TF_007_20151127, RP42/2012, and SP/FSGS1/2013). The Mary Lyon Center is part of the MRC Harwell Institute and is funded by the MRC (A410).

Early diagnosis and predicting of acute kidney injury in children with viral gastroenteritis of various agents (Literature review)

The most common viral infections causing gastroenteritis in children include rotavirus, norovirus, and the SARS-CoV-2. A typical clinical picture includes fever, vomiting, diarrhea, toxicosis and exicosis of varying severity. However, in 30—35% of cases, acute intestinal infections of viral etiology complicate of acute kidney injury (AKI), which significantly aggravates the course of the disease and affects the outcome of the disease. Currently used markers for the diagnosis of AKI are poor informative due to late detection of typical laboratory changes during the clinical picture's change. Currently, there are non-invasive biomarkers of AKI detected before changes in routine biochemical tests and can be used for early diagnosis of kidney damage. Using of these biomarkers in practice will develop of clinical and laboratory differential diagnostic criteria for early diagnosis, risk factors for the development of AKI in children with viral diarrhea of various agents, in order to start timely effective pathogenetic treatment and prevent serious complications.

Advances in pediatric acute kidney injury pathobiology: a report from the 26th Acute Disease Quality Initiative (ADQI) conference

BackgroundIn the past decade, there have been substantial advances in our understanding of the pathobiology of pediatric acute kidney injury (AKI). In particular, animal models and studies focused on the relationship between kidney development, nephron number, and kidney health have identified a number of heterogeneous pathophysiologies underlying AKI. Despite this progress, gaps remain in our understanding of the pathobiology of pediatric AKI.MethodsDuring the 26th Acute Disease Quality Initiative (ADQI) Consensus conference, a multidisciplinary group of experts discussed the evidence and used a modified Delphi process to achieve consensus on recommendations for opportunities to advance translational research in pediatric AKI. The current state of research understanding as well as gaps and opportunities for advancement in research was discussed, and recommendations were summarized.ResultsConsensus was reached that to improve translational pediatric AKI advancements, diverse teams spanning pre-clinical to epidemiological scientists must work in concert together and that results must be shared with the community we serve with patient involvement. Public and private research support and meaningful partnerships with adult research efforts are required. Particular focus is warranted to investigate the pediatric nuances of AKI, including the effect of development as a biological variable on AKI incidence, severity, and outcomes.ConclusionsAlthough AKI is common and associated with significant morbidity, the biologic basis of the disease spectrum throughout varying nephron developmental stages remains poorly understood. An incomplete understanding of factors contributing to kidney health, the diverse pathobiologies underlying AKI in children, and the historically siloed approach to research limit advances in the field. The recommendations outlined herein identify gaps and outline a strategic approach to advance the field of pediatric AKI via multidisciplinary translational research.

Acute kidney injury in children: incidence, awareness and outcome—a retrospective cohort study

The primary objective was to determine the epidemiologic influence of AKI awareness among physicians in a mixt paediatric population, including neonates. This single-centre, multiyear, observational retrospective study included all admitted patients between first of July 2014 and 31 December 2021. AKI was identified in 2194 patients out of the 128,036 hospital admissions with 129,936 serum creatinine measurements. Matching comparisons were used between AKI aware and AKI non-aware patients. The overall incidence of AKI was 1.65%. Stage 1 was identified in 24.24% of the AKI cases, stage 2 in 31.03% and stage 3 in 44.71%. The most prevalent cause of AKI was represented by prerenal AKI in 85.64% of the cases, followed by 12.16% renal causes respectively 2.18% postrenal causes. Exposure to sepsis, critical illness, hypovolemic shock and mechanical ventilation increased mortality by 2.09, 4.69, 4.64- and 4.93-times (p = 0.001). Cancer and heart failure increased mortality by 4.22 (p < 0.001) respectively 2.17 times (p = 0.001). The presence of AKI increased mortality by 79.11 times while only half of the AKI associated deaths were recognized by physicians. AKI increased hospitalization more than 4 times the average stay. AKI awareness was dependent of lower age and severity. Also, awareness increased mortality and prolonged hospitalization. 1 in 3 neonates and 1 in 4 children were AKI aware. The physician’s awareness of AKI diagnosis is in general low due to lack of appliance of current guidelines in exploring exposures and susceptibilities for AKI screening.

The effect of dehydration, hyperchloremia and volume of fluid resuscitation on acute kidney injury in children admitted to hospital with diabetic ketoacidosis.

Acute kidney injury (AKI) is a recognized comorbidity in pediatric diabetic ketoacidosis (DKA), although the exact etiology is unclear. The unique physiology of DKA makes dehydration assessments challenging, and these patients potentially receive excessive amounts of intravenous fluids (IVF). We hypothesized that dehydration is over-estimated in pediatric DKA, leading to over-administration of IVF and hyperchloremia that worsens AKI. Retrospective cohort of all DKA inpatients at a tertiary pediatric hospital from 2014 to 2019. A total of 145 children were included; reasons for exclusion were pre-existing kidney disease or incomplete medical records. AKI was determined by change in creatinine during admission, and comparison to a calculated baseline value. Linear regression multivariable analysis was used to identify factors associated with AKI. True dehydration was calculated from patients' change in weight, as previously validated. Fluid over-resuscitation was defined as total fluids given above the true dehydration. A total of 19% of patients met KDIGO serum creatinine criteria for AKI on admission. Only 2% had AKI on hospital discharge. True dehydration and high serumurea levels were associated with high serumcreatinine levels on admission (p = 0.042; p < 0.001, respectively). Fluid over-resuscitation and hyperchloremia were associated with delayed kidney recovery (p < 0.001). Severity of initial AKI was associated with cerebral edema (p = 0.018). Dehydration was associated with initial AKI in children with DKA. Persistent AKI and delay to recovery was associated with hyperchloremia and over-resuscitation with IVF, potentially modifiable clinical variables for earlier AKI recovery and reduction in long-term morbidity. This highlights the need to re-address fluid protocols in pediatric DKA.

Severe Acute Kidney Injury in Children as a Rare Complication of Paroxysmal Cold Hemoglobinuria.

Paroxysmal cold hemoglobinuria (PCH) is a rare condition in childhood characterized by complement-mediated premature destruction of red blood cells. PCH is associated with intravascular hemolysis causing hemoglobinuria, which may result in acute kidney injury of various severity. We aimed to retrospectively analyze clinical and laboratory features of children with PCH-associated acute kidney injury received at tertiary Pediatric Hematology and Nephrology Center, University Motol Hospital, Prague, Czech Republic during the period 2016 to 2022. We present here 3 children with PCH-associated acute kidney failure requiring renal replacement therapy. We highlight the association of PCH with kidney disease. Renal parameters and urine examination should be regularly tested in all children with PCH.

Acute kidney injury in children with moderate-severe COVID-19 and multisystem inflammatory syndrome in children: a referral center experience.

Data on the characteristics of acute kidney injury (AKI) in pediatric COVID-19 and MIS-C are limited. We aimed to define the frequency, associated factors and early outcome of AKI in moderate, severe or critical COVID-19 and MIS-C; and to present a tertiary referral center experience from Türkiye. Hospitalized patients ≤ 18years of age with confirmed COVID-19 or MIS-C at İhsan Doğramacı Children's Hospital, Hacettepe University, between March 2020-December 2021 were enrolled. The characteristics of AKI in the COVID-19 group were investigated in moderate, severe and critically ill patients; patients with mild COVID-19 were excluded. The median (Q1-Q3) age in theCOVID-19 (n = 66) and MIS-C (n = 111) groups was 10.7years (3.9-15.2) and 8.7years (4.5-12.7), respectively. The frequency of AKI was 22.7% (15/66) in COVID-19 and 15.3% (17/111) in MIS-C; all MIS-C patients with AKI and 73.3% (11/15) of COVID-19 patients with AKI had AKI at the time of admission. Multivariate analyses revealed need for vasoactive/inotropic agents [Odds ratio (OR) 19.233, p = 0.002] and presence of vomiting and/or diarrhea (OR 4.465, p = 0.036) as independent risk factors of AKI in COVID-19 patients; and need for vasoactive/inotropic agents (OR 22.542, p = 0.020), procalcitonin and ferritin levels as independent risk factors of AKI in theMIS-C group. Age was correlated with lymphocyte count (r = -0.513, p < 0.001) and troponin level (r = 0.518, p < 0.001) in MIS-C patients. Length of hospital stay was significantly longer in both groups with AKI, compared to those without AKI. Mortality was 9.1% in theCOVID-19 group; and was associated with AKI (p = 0.021). There was no mortality in MIS-C patients. AKI recovery at discharge was 63.6% in COVID-19 survivors and 100% in MIS-C patients. Independent risk factors for AKI were need for vasoactive/inotropic agents and vomiting/diarrhea in moderate, severe or critical COVID-19 patients; and need for vasoactive/inotropic agents and severe inflammation in MIS-C patients. Our findings suggest that inflammation and cardiac dysfunction are associated with AKI in MIS-C patients; and the association with age in this group merits further studies in larger groups. Early outcome is favorable; long-term follow-up for kidney functions is needed.

Etiological Spectrum and Outcome of Acute Kidney Injury in Children: A Tertiary Care Experience

Objective: To determine the aetiologies and outcomes which would help reduce preventable deaths from acute kidney injury.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Paediatric Nephrology unit at University of Child Health Sciences, The Children’s Hospital Lahore Pakistan, from Aug 2021 to Jul 2022.&#x0D; Methodology: A total of 149 children who fulfilled the selection criteria were included in the study. Kidney Disease: Improving Global Outcomes guidelines were used for defining and staging acute kidney injury. The aetiology for each case of acute kidney injury was determined using standard workup/protocol and classified as pre-renal, renal and post-renal. Outcome parameters were recovery, improvement, death and progression to chronic kidney disease.&#x0D; Results: The mean age of children was 61.79±52.26 months, predominantly boys (68.5%). The most common etiological group was renal (73,49%), followed by pre-renal (53,35.6%) and post-renal (23,15.4%). It was observed that the majority of children had stage-3 AKI (63.8%), with kidney replacement therapy (KRT) given in 92(61.7%) cases. Mortality was seen in 30.9%, while recovery, improvement and death occurred in 69(46.3%), 44(29.5%) and 36(24.2%), respectively, at the time of discharge. At three months of follow-up, recovery, progression to chronic kidney disease, and death occurred in 73(49.0%), 20(13.4%) and 10(6.7%) children, respectively.&#x0D; Conclusion: Intrinsic renal disease was the most common etiological group occurring primarily in the form of AGN, and sepsis was found to be the most common underlying aetiology. Most patients presented in Stage 3 of acute kidney injury, and recovery was seen in many patients.