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

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Abstract

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.

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Authors’ contribution statements

Conceptualization: Yoo KH, Ahn YH, Kim SH, Lee JW, Chung WY, Cho MH, Kim KH, Cho H, Lee MJ, Suh J, Hyun HS, Lee JM, Cho MH2, Kim JH, Ha IS, Cheong HI and Kang HG. Formal analysis: Yang EM. Data curation: Yoo KH, Ahn YH, Kim SH, Lee JW, Chung WY, Cho MH, Kim KH, Cho H, Lee MJ, Suh J, Hyun HS, Lee JM, Cho MH2, Kim JH, Ha IS, Cheong HI and Kang HG. Software: Yang EM. Validation: Kang HG. Writing—original draft preparation: Yang EM. Writing—review and editing: Kang HG. Approval of final manuscript: all authors.

Data and/or code availability

Requests for access to data from the study should be addressed to the corresponding author at kanghg@snu.ac.kr. All proposals requesting data access will need to specify how they plan to use the data, and all proposals will need approval of the trial co-investigator team before data release.

Funding

This work was supported by a research fund from the Korean Society of Pediatric Nephrology (2018).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Chonnam National University Hospital, Gwangju, South Korea

    Eun Mi Yang

  2. Korea University Guro Hospital, Seoul, South Korea

    Kee Hwan Yoo

  3. Seoul National University Children’s Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-Gu, Seoul, 03080, South Korea

    Yo Han Ahn, Il-Soo Ha, Hae Il Cheong & Hee Gyung Kang

  4. Pusan National University Children’s Hospital, Yangsan, South Korea

    Seong Heon Kim

  5. Ewha Womans University, College of Medicine, Seoul, South Korea

    Jung Won Lee

  6. Busan Paik Hospital, Inje University, Busan, South Korea

    Woo Yeong Chung

  7. Kyungpook National University, School of Medicine, Daegu, South Korea

    Min Hyun Cho

  8. NHIC Ilsan Hospital, Goyang, South Korea

    Kee Hyuck Kim

  9. Sungkyunkwan University Samsung Medical Center, Seoul, South Korea

    Heeyeon Cho

  10. Dankook University College of Medicine, Cheonan, South Korea

    Mee Jeong Lee

  11. Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Jin-Soon Suh

  12. St. Vincent’s Hospital, College of Medicine, The Catholic University, Suwan, South Korea

    Hye Sun Hyun

  13. Chungnam National University Hospital, Daejeon, South Korea

    Jiwon M. Lee

  14. Hallym University Sacred Heart Hospital, Anyang, South Korea

    Myung Hyun Cho

  15. Seoul National University Bundang Hospital, Seongnam, South Korea

    Ji Hyun Kim

  16. Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea

    Il-Soo Ha & Hee Gyung Kang

  17. Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea

    Hee Gyung Kang

Authors
  1. Eun Mi Yang
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  2. Kee Hwan Yoo
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Corresponding author

Correspondence to Hee Gyung Kang.

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The authors declare that they have no conflicts of interest.

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The study was approved by the local institutional review boards of all participating centers.

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Informed consent was waived due to the retrospective nature of this study.

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Yang, E.M., Yoo, K.H., Ahn, Y.H. et al. Lower albumin level and longer disease duration are risk factors of acute kidney injury in hospitalized children with nephrotic syndrome. Pediatr Nephrol 36, 701–709 (2021). https://doi.org/10.1007/s00467-020-04740-y

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