Etiology and outcomes of acute kidney disease in children: a cohort study

• Published in: Clinical and experimental nephrology Vol. 27; no. 6; pp. 548 - 556
• Main Authors: Murdeshwar, Amar, Krishnamurthy, Sriram, Parameswaran, Narayanan, Rajappa, Medha, Deepthi, Bobbity, Krishnasamy, Sudarsan, Ganapathy, Sachit, Karunakar, Pediredla
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.06.2023
• Subjects: Acute Disease; Acute Kidney Injury - etiology; Acute Kidney Injury - therapy; Child; Cohort Studies; Glomerulonephritis - complications; Glomerulonephritis - therapy; Hemolytic-Uremic Syndrome - complications; Humans; Medicine; Medicine & Public Health; Nephrology; Original Article; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - etiology; Renal Insufficiency, Chronic - therapy; Retrospective Studies; Urology; Kidney survival; Etiology; Pediatric; Mortality; Risk factors; Acute kidney disease
• ISSN: 1342-1751; 1437-7799
• DOI: 10.1007/s10157-023-02339-9

Background There is paucity of information regarding the etiology and outcomes of Acute Kidney Disease (AKD) in children. Methods The objectives of this cohort study were to evaluate the etiology and outcomes of AKD; and analyze predictors of kidney survival (defined as free of CKD 2, 3a, 3b, 4 or 5). Patients aged 1 month to 18 years who developed AKD over a 4-year-period (January 2018-December 2021) were enrolled. Survivors were followed-up at the pediatric nephrology clinic, and screened for residual kidney injury. Results Among 5710 children who developed AKI, 200 who developed AKD were enrolled. The median (IQR) eGFR was 17.03 (10.98, 28) mL/min/1.73 m 2 . Acute glomerulonephritis, acute tubular necrosis (ATN), hemolytic uremic syndrome (HUS), sepsis-associated AKD, and snake envenomation comprised of 69 (34.5%), 39 (19.5%), 24 (12%), 23 (11.5%) and 15 (7.5%) of the patients respectively. Overall, 88 (44%) children required kidney replacement therapy (KRT). There were 37 (18.5%) deaths within the AKD period. At a follow-up of 90 days, 32 (16%) progressed to chronic kidney disease stage-G2 or greater. At a median (IQR) follow-up of 24 (6, 36.5) months (n = 154), 27 (17.5%) had subnormal eGFR, and 20 (12.9%) had persistent proteinuria and/or hypertension. Requirement of KRT predicted kidney survival (free of CKD 2, 3a, 3b, 4 or 5) in AKD (HR 6.7, 95% CI 1.2, 46.4) (p 0.04). Conclusions Acute glomerulonephritis, ATN, HUS, sepsis-associated AKD and snake envenomation were common causes of AKD. Mortality in AKD was 18.5%, and 16% progressed to CKD-G2 or greater at 90-day follow-up.