Predictors and outcome of acute kidney injury after non-cardiac paediatric surgery

Abstract

Background: It is necessary to define the problem of acute kidney injury (AKI) after non-cardiac surgery in order to design interventions to prevent AKI. The study aimed to evaluate the occurrence, determinants and outcome of AKI among children undergoing general (non-cardiac) surgery. Methods: This was a prospective cohort study of patients aged ≤ 15 years who had general surgery over 18 months period at a tertiary hospital in Nigeria. AKI was evaluated at 6 and 24 h and within 7 days of surgery. Data were analysed using SPSS version 21. Results: A total of 93 patients were studied with age ranging from 3 days to 15 years (median = 4 years). AKI occurred within 24 h of surgery in 32 (34.4%) and cumulatively over 7 days in 33 (35.5%). Patients who had sepsis were nearly four times as likely as others to develop perioperative AKI (OR = 3.52, 95% CI 1.21, 10.20, p = 0.021). Crude mortality rate was 12.1% (4/33); no mortality was recorded among those without AKI, p = 0.014. Conclusion: Perioperative AKI occurred in 35.5% of children who underwent general (non-cardiac) surgery. Patients who had sepsis were four times more likely than others to develop AKI. Mortality was documented only in patients who had AKI.

Modifiable factors affecting renal preservation in type I glycogen storage disease after liver transplantation: a single-center propensity-match cohort study

“…In our cohort, however, post-LT AKI was not associated with inferior renal outcomes in GSD and BA groups. The reasons might come from that LT surgery was the main etiology of AKI rather than sepsis and the full recovery of renal function in our patients, both of which were proved to be good indicators of AKI prognosis [ 28 – 30 ].…”

Acute kidney injury in pediatrics: an overview focusing on pathophysiology

“…The cardiopulmonary bypass (CPB) used in these procedures may also induce AKI through hypoperfusion due to a lower and nonpulsatile flow with hemodilution, decreasing the capacity of carrying oxygen and resulting in hypothermia [63]. CPB can also trigger an inflammatory response that leads to afferent arteriolar constriction [63] Major non-cardiac surgeries are also associated with AKI, which may also lead to CKD and death [64,65]. As almost 20% of children from low-income countries are likely to need surgery, it can be inferred that exposure to major surgery is an important factor to be considered as a cause of AKI in this population [65].…”

“…CPB can also trigger an inflammatory response that leads to afferent arteriolar constriction [63] Major non-cardiac surgeries are also associated with AKI, which may also lead to CKD and death [64,65]. As almost 20% of children from low-income countries are likely to need surgery, it can be inferred that exposure to major surgery is an important factor to be considered as a cause of AKI in this population [65]. Even though cardiac surgery is an established risk factor for the development of AKI, the role of other surgeries in this scenario is still not yet settled in the literature [65].…”

“…As almost 20% of children from low-income countries are likely to need surgery, it can be inferred that exposure to major surgery is an important factor to be considered as a cause of AKI in this population [65]. Even though cardiac surgery is an established risk factor for the development of AKI, the role of other surgeries in this scenario is still not yet settled in the literature [65].…”

Effects of continuous renal replacement therapy with the AN69ST membrane for septic shock and sepsis-induced AKI in an infant: a case report with literature review of cytokine/mediator removal therapy in children

“…Patients with sepsis and septic shock also often develop acute kidney injury (AKI), leading to electrolyte abnormalities, metabolic acidosis, and fluid overload. The reported mortality from AKI in children ranges from 1.2 to 50.7%, and AKI is associated with the need for renal replacement therapy [2]. Continuous renal replacement therapy (CRRT) may be effective for such septic conditions, in addition to conservative therapy.…”