Prognosis for children with acute kidney injury in the intensive care unit

Abstract

To define factors of prognostic importance for critically ill infants and children with acute kidney injury (AKI), we have studied 110 children, ages from 1 month to 180 months, admitted between March 1, 2002 and September 30, 2004 to the intensive care unit of Joana de Gusmão Children's Hospital. These patients represent 8% of all intensive care unit admissions during the entire study period. The diagnosis at admission was primary renal parenchyma disease (eight patients, 7.2%) and secondary renal disease (102 patients, 92.8%). Thirty-seven patients (33.6%) died, all of whom had secondary renal insufficiency; six patients (5.4%) died as a result of septic shock, and 31 (28.2%) patients died from multiple organ failure (MOF). The variables were analyzed using Fisher's exact test for qualitative variables and Student's t-test for quantitative variables. Stratified analysis was performed to assess the relative importance of variables using the Mantel-Haenszel technique. Among the variables analyzed, the following were found to be significantly related to mortality: anuria, oliguria, arterial hypotension, need for pressor drugs, need for mechanical ventilation, need for dialysis, the association with MOF, and high values of lactic acid.

Lesão renal aguda em crianças: incidência e fatores prognósticos em pacientes gravemente enfermos

“…Regarding mortality, several studies (5,7,9,16,19,22,26) have clearly shown that any degree of AKI is a poor prognosis indicator for critically ill patients. In this sample, we found that the in-hospital mortality of patients with the condition was ten times bigger than in the group with no AKI, according to the pRIFLE.…”

“…(17,18) The AKI diagnosis methods include: clinical evaluation of the urinary output and laboratory tests as urinalysis, blood urea nitrogen, and creatinine, however with low sensitivity and specificity. (19) Biomarkers for early AKI detection are currently under investigation, among them neutrophil gelatinase associated lipocalin (NGAL), cystatin C, interleukin 18, and kidney injury molecule-1 (KIM-1). (20) Although these markers have good sensitivity and specificity, they are not routinely used due to their low availability and high costs.…”

“…(20) Although these markers have good sensitivity and specificity, they are not routinely used due to their low availability and high costs. (19,20) In this context, the Acute Dialysis Quality Initiative (ADQI), which involves the participation of nephrologists and intensivists, held in 2002 in the city of Vicenza the Second International Consensus Conference of the ADQI. (21) where adult AKI diagnosis criteria were proposed and decided, and detailed published in 2004 with the name RIFLE criteria.…”

Pancreatic Injury in Rabbits with Acute Renal Failure

“…[4] A recent study reported six patients (5.4%) who died as a result of septic shock, and 31 (28.2%) patients who died from multiple organ failure (MOF) in 110 children with AKI. [5] Continuous blood purification (CBP) is effective for treatment of MOF and may help reduce the mortality rate of MOF complicated by ARF. [6] Thus, it is important to prevent ensuing other organ dysfunction and even MODS, which could decrease the mortality.…”

Daño renal agudo en niños críticos: incidencia y factores de riesgo de mortalidad

“…[4][5][6][7][8] Inicialmente, la ausencia de una definición consensuada de daño renal agudo determinó una amplia variación en la incidencia y la mortalidad entre los estudios comunicados y dificultó obtener conclusiones comparables entre los distintos centros. 2,[4][5][6][7][8] En el año 2004, el grupo ADQI (Acute Dialysis Quality Initiative) propuso el cambio del término insuficiencia por daño para enfocar la atención del médico en el reconocimiento temprano de la lesión renal y así prevenir la falla, última etapa del daño. 9,10 A s í , f u e c o n s e n s u a d a u n a clasificación para pacientes adultos con daño renal agudo denominada Criterios RIFLE (risk "riesgo", injury "daño", failure "falla", loss "pérdida", end stage kidney disease "enfermedad renal terminal"), tomando en cuenta dos parámetros para definir el daño renal agudo: el filtrado glomerular y la diuresis.…”