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Acute Kidney Injury in ADPKD Patients with Pneumonia
Carlos Franco Palacios1, Mira T Keddis, Dingxin Qin
1Division of Nephrology and Hypertension, Department of Medicine, Mayo Medical School, 200 First Street SW, Rochester, MN 55905, USA.
Insights
Patients with autosomal dominant polycystic kidney disease (ADPKD) admitted for pneumonia experienced significantly more acute kidney injury (AKI) than those without ADPKD. This increased susceptibility highlights a critical vulnerability in ADPKD patients facing acute illness.
Area of Science:
- Nephrology
- Pulmonology
- Critical Care Medicine
Background:
- Polycystic kidneys in animal models show susceptibility to acute kidney injury (AKI).
- Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder characterized by kidney cyst development.
- Pneumonia is a common cause of hospitalization and can precipitate AKI.
Purpose of the Study:
- To investigate the occurrence of AKI in patients with ADPKD and acute pneumonia.
- To compare AKI incidence between ADPKD and non-ADPKD patients with pneumonia.
- To assess the outcomes associated with AKI in these patient groups.
Main Methods:
- Retrospective cohort study of ADPKD patients admitted for pneumonia (1990-2010).
- Exclusion criteria included dialysis, transplantation, and chronic immunosuppression.
- ADPKD patients were matched 1:4 with non-ADPKD pneumonia patients based on baseline estimated glomerular filtration rate (eGFR).
- AKI defined as serum creatinine elevation ≥0.3 mg/dL.
Main Results:
- 16 of 23 ADPKD patients (69.6%) developed AKI compared to 36 of 92 non-ADPKD patients (39.1%) (P = 0.008).
- Patients who developed AKI had lower baseline eGFR, more ICU admissions, and longer hospital stays in both groups.
- AKI was associated with reduced survival in both ADPKD and non-ADPKD patients.
Conclusions:
- ADPKD patients admitted for acute pneumonia have a higher incidence of AKI compared to non-ADPKD patients with similar kidney function.
- AKI represents a significant complication in ADPKD patients with pneumonia, impacting survival.
- Further research may be warranted to explore mechanisms and preventive strategies for AKI in ADPKD.
Abstract:
Background. In animal models, polycystic kidneys are susceptible to acute kidney injury (AKI). We examined the occurrence of AKI in a cohort of autosomal dominant polycystic kidney disease (ADPKD) and non-ADPKD patients with acute pneumonia. Design. All ADPKD patients admitted to Mayo Clinic Rochester for pneumonia from January 1990 to April 2010 were examined. Sixty-three patients had lobar infiltration and consolidation on chest X-ray. After excluding patients on dialysis, with organ transplantation, and on chronic immunosuppression, 24 remaining ADPKD patients were enrolled. Twenty-three of the 24 were matched with 92 (1 : 4 ratio) non-ADPKD pneumonia patients based on their baseline eGFR. AKI was defined as serum creatinine elevation ≥0.3 mg/dL. Results. Sixteen of the 23 ADPKD patients (69.6%) and 36 of the 92 (39.1%) non-ADPKD patients developed AKI, P = 0.008. In both groups, those who developed AKI had a lower baseline eGFR (41.1 ± 5.00 versus 58.7 ± 11.8 in ADPKD and 40.2 ± 3.65 versus 51.8 ± 2.24 mL/min/1.73 m(2) in the non-ADPKD group), more intensive care unit admissions, and longer hospital stays. AKI was associated with a reduced survival in both groups. Conclusions. Patients with ADPKD admitted for acute pneumonia had more frequent episodes of AKI than non-ADPKD patients with comparable kidney function.
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