Defining pediatric community-acquired acute kidney injury: an observational study

OʼNeil, Erika R; Devaraj, Sridevi; Mayorquin, Lesby; Starke, Hannah; Buffone, Gregory J.; Loftis, Laura; Akcan-Arikan, Ayse; Cruz, Andrea T.

doi:10.1038/s41390-019-0577-3

Cited by 7 publications

(5 citation statements)

References 21 publications

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“…Concerning short-term outcomes, several studies have concluded that AKI in hospitalized pediatric patients may lead to prolonged mechanical ventilation, longer length of stay, and greater mortality 3,7,18,21 . Also, AKI may be associated with later development of proteinuria, hypertension, and chronic kidney disease 3,7,9,18,19,[22][23][24] .…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology

Figueiredo,

Rocha,

Silva

et al. 2024

Braz. J. Nephrol.

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Introduction: Acute kidney injury (AKI) is an abrupt deterioration of kidney function. The incidence of pediatric AKI is increasing worldwide, both in critically and non-critically ill settings. We aimed to characterize the presentation, etiology, evolution, and outcome of AKI in pediatric patients admitted to a tertiary care center. Methods: We performed a retrospective observational single-center study of patients aged 29 days to 17 years and 365 days admitted to our Pediatric Nephrology Unit from January 2012 to December 2021, with the diagnosis of AKI. AKI severity was categorized according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The outcomes considered were death or sequelae (proteinuria, hypertension, or changes in renal function at 3 to 6 months follow-up assessments). Results: Forty-six patients with a median age of 13.0 (3.5–15.5) years were included. About half of the patients (n = 24, 52.2%) had an identifiable risk factor for the development of AKI. Thirteen patients (28.3%) were anuric, and all of those were categorized as AKI KDIGO stage 3 (p < 0.001). Almost one quarter (n = 10, 21.7%) of patients required renal replacement therapy. Approximately 60% of patients (n = 26) had at least one sequelae, with proteinuria being the most common (n = 15, 38.5%; median (P25–75) urinary protein-to-creatinine ratio 0.30 (0.27–0.44) mg/mg), followed by reduced glomerular filtration rate (GFR) (n = 11, 27.5%; median (P25–75) GFR 75 (62–83) mL/min/1.73 m2). Conclusions: Pediatric AKI is associated with substantial morbidity, with potential for proteinuria development and renal function impairment and a relevant impact on long-term prognosis.

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Section: Introductionmentioning

confidence: 99%

Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology

Figueiredo,

Rocha,

Silva

et al. 2024

Braz. J. Nephrol.

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“…A final option for patients without a known baseline, is to apply an age-based normative creatinine value. In this scenario, a population-based serum creatinine is assigned to each patient based on their demographic characteristics (23,24). Each of these potential solutions have been validated and, ultimately, the approach applied should reflect the goals of the diagnostic tool.…”

Section: Aki Identification and Diagnosismentioning

confidence: 99%

“…Most studies to date have back calculated the imputed serum creatinine using an estimated creatinine clearance of 120 mL/min/1.73 m 2 . However, using an age based normative value may be equally effective and will reduce computational requirements (3,24); either approach should be considered valid. With regard to UOP, it is important to note that studies in adults and children demonstrate that some children meet only the UOP criteria for AKI; non-application of these KDIGO thresholds may underestimate AKI incidence (3,27).…”

Section: Aki Identification and Diagnosismentioning

confidence: 99%

Big Data and Pediatric Acute Kidney Injury: The Promise of Electronic Health Record Systems

Sutherland

2020

Front. Pediatr.

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Over the last decade, our understanding of acute kidney injury (AKI) has evolved considerably. The development of a consensus definition standardized the approach to identifying and investigating AKI in children. As a result, pediatric AKI epidemiology has been refined and the consequences of renal injury are better established. Similarly, "big data" methodologies experienced a dramatic evolution and maturation, leading the critical care community to explore potential AKI/big data synergies. One such concept with tremendous potential is electronic health record (EHR) enabled informatics. Much of the promise surrounding these approaches is due to the unique position of the EHR which sits at the intersection of data accumulation and care delivery. EHR data is generated simply via the provision of routine clinical care and should be considered "big" from the standpoint of volume, variety, and velocity as a myriad of diverse elements accumulate rapidly in real time, spontaneously generating an immense dataset. This massive dataset interfaces directly with providers which creates tremendous opportunity. AKI can be diagnosed more accurately, AKI-related care can be optimized, and subsequent outcomes can be improved. Although applying big data concepts to the EHR has proven more challenging than originally thought, we have seen much success and continue to explore its potential. In this review article, we will discuss the EHR in the context of big data concepts, describe approaches applied to date, examine the challenges surrounding optimal application, and explore future directions.

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“…Com relação aos desfechos de curto prazo, diversos estudos têm concluído que a IRA em pacientes pediátricos hospitalizados pode levar à ventilação mecânica prolongada, maior tempo de internação e maior mortalidade 3,7,18,21 . Além disso, a IRA pode estar associada ao desenvolvimento posterior de proteinúria, hipertensão e doença renal crônica 3,7,9,18,19,[22][23][24] .…”

Section: Introductionunclassified

Insuficiência renal aguda: experiência de um centro terciário de Nefrologia Pediátrica

Figueiredo,

Rocha,

Silva

et al. 2024

Braz. J. Nephrol.

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RESUMO Introdução: Insuficiência renal aguda (IRA) é uma deterioração abrupta da função renal. A incidência de IRA pediátrica está aumentando em todo o mundo, em ambientes críticos e não críticos. Nosso objetivo foi caracterizar apresentação, etiologia, evolução e desfechos da IRA em pacientes pediátricos internados em um centro de atendimento terciário. Métodos: Realizamos estudo retrospectivo observacional de centro único de pacientes com idade entre 29 dias a 17 anos e 365 dias internados em nossa Unidade de Nefrologia Pediátrica, de janeiro de 2012 a dezembro de 2021, com diagnóstico de IRA. A gravidade da IRA foi categorizada de acordo com os critérios do Kidney Disease Improving Global Outcomes (KDIGO). Os desfechos considerados foram óbito ou sequelas (proteinúria, hipertensão ou alterações na função renal em avaliações de acompanhamento de 3 a 6 meses). Resultados: Incluímos 46 pacientes com idade mediana de 13,0 (3,5–15,5) anos. Cerca de metade (n = 24; 52,2%) apresentou um fator de risco identificável para o desenvolvimento de IRA. Treze pacientes (28,3%) eram anúricos; todos foram classificados como IRA KDIGO 3 (p < 0,001). Quase um quarto (n = 10; 21,7%) dos pacientes necessitaram de terapia renal substitutiva. Aproximadamente 60% (n = 26) apresentou pelo menos uma sequela, sendo proteinúria a mais comum (n = 15; 38,5%; mediana (P25–75) da relação proteína/creatinina urinária 0,30 (0,27–0,44) mg/mg), seguida de taxa de filtração glomerular (TFG) reduzida (n = 11; 27,5%; mediana (P25–75) da TFG 75 (62–83) mL/min/1,73 m2). Conclusões: A IRA pediátrica está associada à morbidade substancial, com potencial para desenvolvimento de proteinúria e comprometimento da função renal e impacto relevante no prognóstico de longo prazo.

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Defining pediatric community-acquired acute kidney injury: an observational study

Cited by 7 publications

References 21 publications

Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology

Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology

Big Data and Pediatric Acute Kidney Injury: The Promise of Electronic Health Record Systems

Insuficiência renal aguda: experiência de um centro terciário de Nefrologia Pediátrica

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