Lower albumin level and longer disease duration are risk factors of acute kidney injury in hospitalized children with nephrotic syndrome.,Pediatric Nephrology

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Lower albumin level and longer disease duration are risk factors of acute kidney injury in hospitalized children with nephrotic syndrome.
Pediatric Nephrology ( IF 2.6 ) Pub Date : 2020-09-05 , DOI: 10.1007/s00467-020-04740-y
Eun Mi Yang ₁ , Kee Hwan Yoo ₂ , Yo Han Ahn ₃ , Seong Heon Kim ₄ , Jung Won Lee ₅ , Woo Yeong Chung ₆ , Min Hyun Cho ₇ , Kee Hyuck Kim ₈ , Heeyeon Cho ₉ , Mee Jeong Lee ₁₀ , Jin-Soon Suh ₁₁ , Hye Sun Hyun ₁₂ , Jiwon M Lee ₁₃ , Myung Hyun Cho ₁₄ , Ji Hyun Kim ₁₅ , Il-Soo Ha _{3,

16} , Hae Il Cheong ₃ , Hee Gyung Kang _{3,

16,

17}

Affiliation

Department of Pediatrics, Chonnam National University Hospital, Gwangju, South Korea.
Korea University Guro Hospital, Seoul, South Korea.
Seoul National University Children's Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-Gu, Seoul, 03080, South Korea.
Pusan National University Children's Hospital, Yangsan, South Korea.
Ewha Womans University, College of Medicine, Seoul, South Korea.
Busan Paik Hospital, Inje University, Busan, South Korea.
Kyungpook National University, School of Medicine, Daegu, South Korea.
NHIC Ilsan Hospital, Goyang, South Korea.
Sungkyunkwan University Samsung Medical Center, Seoul, South Korea.
Dankook University College of Medicine, Cheonan, South Korea.
Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
St. Vincent's Hospital, College of Medicine, The Catholic University, Suwan, South Korea.
Chungnam National University Hospital, Daejeon, South Korea.
Hallym University Sacred Heart Hospital, Anyang, South Korea.
Seoul National University Bundang Hospital, Seongnam, South Korea.
Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.
Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea.

Background

Children with nephrotic syndrome (NS) are at an increased risk of acute kidney injury (AKI) and the incidence of AKI in this population is reportedly increasing. This study aimed to investigate the incidence, clinical profiles, and risk factors of AKI in hospitalized children with NS through a nationwide study.

Methods

This retrospective multicenter study included 14 pediatric nephrology centers in Korea. From 2013 to 2017, a total of 814 patients with idiopathic NS were cared for at participating centers. Among them, 363 patients were hospitalized for NS and investigated in this study.

Results

A total of 363 children with NS were hospitalized 574 times. AKI occurred in 93 admissions (16.2%) of 89 patients: 30 (32.3%) stage 1; 24 (25.8%) stage 2; and 39 (41.9%) stage 3. Multivariate logistic regression analysis showed that longer disease duration, lower albumin level, and methylprednisolone pulse treatment were significantly associated with AKI development in hospitalized children with NS. AKI was associated with a longer hospital stay than non-AKI (median 10 vs. 7 days, P = 0.001). Among 93 admissions, 85 (91.4%) episodes recovered from AKI without complication, whereas 6 (6.5%) progressed to advanced chronic kidney disease (CKD).

Conclusions

AKI is not uncommon in hospitalized children with NS, and its incidence in this nationwide study was 16.2%. Risk factors for AKI in hospitalized children with NS include longer disease duration, lower albumin level, and methylprednisolone pulse therapy. Pediatric NS patients with these characteristics should be under more strict scrutiny for the occurrence of AKI.

中文翻译：

白蛋白水平较低和病程较长是肾病综合征住院患儿发生急性肾损伤的危险因素。

背景

患有肾病综合征 (NS) 的儿童发生急性肾损伤 (AKI) 的风险增加，据报道该人群中 AKI 的发病率正在增加。本研究旨在通过一项全国性研究调查 NS 住院儿童 AKI 的发生率、临床特征和危险因素。

方法

这项回顾性多中心研究包括韩国的 14 个儿科肾脏病中心。从 2013 年到 2017 年，共有 814 名特发性 NS 患者在参与中心接受治疗。其中，363 名患者因 NS 住院并在本研究中进行调查。

结果

共有363名NS患儿住院574次。89 名患者中有 93 名 (16.2%) 发生 AKI：30 名 (32.3%) 为第 1 期；24 (25.8%) 第二阶段；和 39 (41.9%) 阶段 3。多变量逻辑回归分析显示，NS 住院儿童病程较长、白蛋白水平较低和甲基强的松龙脉冲治疗与 AKI 发展显着相关。与非 AKI 相比，AKI 与更长的住院时间相关（中位数 10 天与 7 天，P = 0.001）。在 93 例入院患者中，85 例 (91.4%) 从 AKI 中恢复而无并发症，而 6 例 (6.5%) 进展为晚期慢性肾病 (CKD)。