Acute Kidney Injury in a Single Pediatric Intensive Care Unit in Poland: A Retrospective Study

Abstract

Background/Aims: The recent improvements of management of patients in pediatric intensive care units (PICU) are associated with improved outcome. However, this decrease in mortality is associated with an increased number of children with acute kidney injury (AKI), especially in patients with multiorgan failure. Methods: The report presents a retrospective analysis of 25 cases of AKI (assessed based on the pRIFLE criteria) in PICU within 7 years. Results: AKI was diagnosed in 1.24% of all hospitalized children. AKI percentage duration (as compared to the total hospitalization time) in the children who died vs. the survivors was 79.55% vs. 46.19%, respectively (p<0.05). The mortality rate of AKI patients was 40% which was 4.4-times higher as compared to the total mortality rate in PICU. The final cumulative survival ratio (FCSR) of patients meeting the oliguria criterion (which was met in 48% of AKI patients) was 37% vs. 49% in non-oliguric children. Averaged urine output values in the first week of hospitalization in the deceased vs. survivors were 1.49 vs. 2.57 ml/kg/h, respectively (p<0.05). Conclusions: Oliguria should not be considered as a sensitive parameter for AKI diagnosing in children below one year of age. A decreased mean urine output in the first week of PICU hospitalization (less than 1.4 ml/kg/h) should be considered as a poor prognostic factor. In many cases AKI was diagnosed too infrequently and too late.

Serum cystatin is a useful marker for the diagnosis of acute kidney injury in critically ill children: prospective cohort study

“…The mortality rate is high among children admitted to ICUs who are diagnosed with AKI, with reported rates ranging from 40 to 46 % [ 19 – 21 ]. A study conducted in Poland showed that AKI is associated with a 4.4 times higher risk of death compared with the total mortality rate for PICU patients [ 22 ]. Another study conducted in Canada has reported that AKI is an independent risk factor for mortality, a longer length of hospital stay and prolonged mechanical ventilation in critically ill children [ 23 ].…”

Acute kidney injury after pediatric cardiac surgery

“…Higher risk adjustment for congenital heart surgery (RACHS-1) scores (3 and above) 12,13 Presence of cyanotic lesions 10 Uncorrected or residual cardiac defects 4 Cardiopulmonary bypass (nonpulsatile flow; inflammatory cascade) 12 Longer cardiopulmonary bypass time 12 Hypothermic circulatory arrest 34 Requirement of inotropic support 10,12 Low cardiac output syndrome 12 Prolonged ventilator requirement 14 Need for extracorporeal membrane oxygenation (ECMO) 35 Early fluid overload 14…”

Evaluation of Vitamin C Supplementation on Kidney Function and Vascular Reactivity Following Renal Ischemic Injury in Mice

“…Acute renal failure (ARF) is a very common event which usually leads to development of chronic kidney disease [1,2]. Ischemia/reperfusion injury (IRI) is an unavoidable consequence of organ transplantation procedure [3].…”