Hyperglycemia and acute kidney injury in critically ill children

Abstract

and hypertension, stony Brook children's hospital, stony Brook, NY, Usa Background: Hyperglycemia and acute kidney injury (AKI) are common in critically ill children and have been associated with higher morbidity and mortality. The incidence of AKI in children is difficult to estimate because of the lack of a standard definition for AKI. The pediatric RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria can be used to define AKI in children. Various biomarkers in urine and blood have been studied to detect AKI in critically ill children. However, it is not clear whether hyperglycemia is associated with AKI. Our objective was to evaluate the effect of hyperglycemia on kidney function and its effect on neutrophil gelatinase-associated lipocalin (NGAL) in children. Methods: We studied retrospective and prospective cohorts of pediatric critically ill subjects admitted to the pediatric intensive care unit (PICU). We analyzed data from admission that included estimated glomerular filtration rate, plasma and urine NGAL, serum glucose and peak glycemia (highest glycemia during PICU admission), and length of hospital and PICU stay from two different institutions. Results: We found that the prevalence of hyperglycemia was 89% in the retrospective cohort and 86% in the prospective cohort, P=0.99. AKI was associated with peak glycemia, P=0.03. There was a statistically significant correlation between peak glycemia and hospital and PICU stays, P=<0.001 and P<0.001, respectively. Urine NGAL and plasma NGAL were not statistically different in subjects with and without hyperglycemia, P=0.99 and P=0.85, respectively. Subjects on vasopressors had lower estimated glomerular filtration rate and higher glycemia, P=0.01 and P=0.04, respectively. Conclusion: We conclude that in critically ill children, hyperglycemia is associated with AKI and longer PICU stays.

Tight glycemic control in critically ill pediatric patients: a systematic review and meta-analysis

“…Hyperglycemia is prevalent in patients in the pediatric intensive care unit (PICU), with more than 80% having a blood glucose concentration greater than 110 mg/dl, more than 60% a concentration greater than 150 mg/dl, and more than 30% a concentration exceeding 200 mg/dl [ 1 – 4 ]. The extent of hyperglycemia is associated with adverse outcomes, including organ failure, length of stay in the PICU, and death [ 1 , 5 – 9 ]. Consequently, the practice of tight glucose control (TGC) with insulin treatment in critically ill children has emerged as a plausible strategy to improve outcomes.…”

Pediatric Acute Kidney Injury: Focusing on Diagnosis and Management

“…For critically ill children with AKI, nutritional requirements should be individualized and assessed frequently 56) . In general, 120-130% of basal calories needs, and 2-3 g/kg/day of protein should be pro vided 56) , and hyperglycemia should be avoided 57) .…”

Az extrém alacsony születési súlyú koraszülöttek hyperglykaemiájának korai és késői szövődményei

“…Először 2016-ban számoltak be arról, hogy a hyperglykaemia akut vesekárosodást okozhat intenzív osztályon kezelt, súlyosan beteg gyermekekben. Minden 10 mg/dl vércukor-emelkedés 10%-kal növelte az akut vesekárosodás lehetőségét [46].…”

“…Az emberi szervezetben az anyagcsere-folyamatok a proximalis tubulusokban és a fotoreceptorokban zajlanak a leggyorsabban, a hyperglykaemia pedig ezeken a területeken gátolja a mitokondriális oxidatív folyamatokat [46,47]. Adatok vannak arra vonatkozóan, hogy a hyperglykaemia a vese strukturális fejlődését is befolyásolja [48].…”