Biology of sepsis: Its relevance to pediatric nephrology

Blatt, Neal B.; Srinivasan, Shardha; Mottes, Theresa; Shanley, Maureen M.; Shanley, Thomas P.

doi:10.1007/s00467-013-2677-3

Cited by 23 publications

(10 citation statements)

References 96 publications

(118 reference statements)

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“…Impaired hemodynamic and hypotension, recognised features of severe sepsis, may lead to an under-perfusion of kidneys and acute kidney injury in severely malnourished children. Additionally, tubular cell apoptosis and microvascular thrombosis, both driven by systemic release of proinflammatory cytokines and features of severe sepsis, are important contributors to acute kidney injury in such children [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study

et al. 2015

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BackgroundIn developing countries, there is no published report on predicting factors of severe sepsis in severely acute malnourished (SAM) children having pneumonia and impact of fluid resuscitation in such children. Thus, we aimed to identify predicting factors for severe sepsis and assess the outcome of fluid resuscitation of such children.MethodsIn this retrospective case-control study SAM children aged 0–59 months, admitted to the Intensive Care Unit (ICU) of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh from April 2011 through July 2012 with history of cough or difficult breathing and radiologic pneumonia, who were assessed for severe sepsis at admission constituted the study population. We compared the pneumonic SAM children with severe sepsis (cases = 50) with those without severe sepsis (controls = 354). Severe sepsis was defined with objective clinical criteria and managed with fluid resuscitation, in addition to antibiotic and other supportive therapy, following the standard hospital guideline, which is very similar to the WHO guideline.ResultsThe case-fatality-rate was significantly higher among the cases than the controls (40% vs. 4%; p<0.001). In logistic regression analysis after adjusting for potential confounders, lack of BCG vaccination, drowsiness, abdominal distension, acute kidney injury, and metabolic acidosis at admission remained as independent predicting factors for severe sepsis in pneumonic SAM children (p<0.05 for all comparisons).Conclusion and SignificanceWe noted a much higher case fatality among under-five SAM children with pneumonia and severe sepsis who required fluid resuscitation in addition to standard antibiotic and other supportive therapy compared to those without severe sepsis. Independent risk factors and outcome of the management of severe sepsis in our study children highlight the importance for defining optimal fluid resuscitation therapy aiming at reducing the case fatality in such children.

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Section: Discussionmentioning

confidence: 99%

Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study

et al. 2015

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“…Neonates who develop sepsis are classically thought to be predisposed to AKI secondary to the hypotension associated with systemic inflammation, but there also appears to be a direct impact on the kidneys. 56 Furthermore, AKI may develop despite the maintenance of systemic blood pressures and renal blood flow, suggesting that sepsis may directly damage the kidney by effects on microvasculature. [56][57][58][59] …”

Section: Sepsismentioning

confidence: 99%

“…56 Furthermore, AKI may develop despite the maintenance of systemic blood pressures and renal blood flow, suggesting that sepsis may directly damage the kidney by effects on microvasculature. [56][57][58][59] …”

Section: Sepsismentioning

confidence: 99%

Neonatal Acute Kidney Injury

et al. 2015

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In recent years, there have been significant advancements in our understanding of acute kidney injury (AKI) and its impact on outcomes across medicine. Research based on single-center cohorts suggests that neonatal AKI is very common and associated with poor outcomes. In this state-of-the-art review on neonatal AKI, we highlight the unique aspects of neonatal renal physiology, definition, risk factors, epidemiology, outcomes, evaluation, and management of AKI in neonates. The changes in renal function with gestational and chronologic age are described. We put forth and describe the neonatal modified Kidney Diseases: Improving Global Outcomes AKI criteria and provide the rationale for its use as the standardized definition of neonatal AKI. We discuss risk factors for neonatal AKI and suggest which patient populations may warrant closer surveillance, including neonates ,1500 g, infants who experience perinatal asphyxia, near term/ term infants with low Apgar scores, those treated with extracorporeal membrane oxygenation, and those requiring cardiac surgery. We provide recommendations for the evaluation and treatment of these patients, including medications and renal replacement therapies. We discuss the need for long-term follow-up of neonates with AKI to identify those children who will go on to develop chronic kidney disease. This review highlights the deficits in our understanding of neonatal AKI that require further investigation. In an effort to begin to address these needs, the Neonatal Kidney Collaborative was formed in 2014 with the goal of better understanding neonatal AKI, beginning to answer critical questions, and improving outcomes in these vulnerable populations.

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“…14 It is becoming clear that sepsis-associated AKI is distinct in pathophysiology from other forms of AKI. 11,14,15 Human and animal studies of sepsis have shown that despite systemic hypotension, renal blood flow in sepsis is largely preserved calling into question previous beliefs that hypotension was the primary driver of sepsis-associated AKI. 16,17 Furthermore, studies have shown that direct damage to the kidney microvasculature may be an important part of the mechanism of sepsis-associated AKI.…”

Section: Continuous Renal Replacement Therapymentioning

confidence: 99%