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

Amar Murdeshwar1, Sriram Krishnamurthy2, Narayanan Parameswaran1

  • 1Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.

Clinical and Experimental Nephrology
|March 19, 2023
PubMed

Insights

This study investigated acute kidney disease (AKD) in children, finding common causes like glomerulonephritis and ATN. AKD carries significant mortality and progression to chronic kidney disease, highlighting the need for better understanding and management.

Area of Science:

  • Pediatric Nephrology
  • Renal Medicine
  • Critical Care Pediatrics

Background:

  • Information on the causes and outcomes of acute kidney disease (AKD) in pediatric populations is limited.
  • Understanding AKD etiology and prognosis is crucial for improving patient care and outcomes.

Purpose of the Study:

  • To determine the common causes of AKD in children.
  • To evaluate the short-term and long-term outcomes of AKD, including mortality and progression to chronic kidney disease (CKD).
  • To identify predictors of kidney survival in pediatric AKD patients.

Main Methods:

  • A cohort study enrolled 200 children (1 month to 18 years) who developed AKD between January 2018 and December 2021.
  • Patients were followed up in a pediatric nephrology clinic to assess kidney injury and survival.
  • Kidney survival was defined as being free of CKD stages G2-G5.

Main Results:

  • The most frequent causes of AKD were acute glomerulonephritis (34.5%), acute tubular necrosis (ATN) (19.5%), and hemolytic uremic syndrome (HUS) (12%).
  • Mortality within the AKD period was 18.5%, and 16% progressed to CKD stage G2 or greater within 90 days.
  • Requirement of kidney replacement therapy (KRT) was a significant predictor of poor kidney survival (HR 6.7, p=0.04).

Conclusions:

  • Acute glomerulonephritis, ATN, HUS, sepsis-associated AKD, and snake envenomation are primary causes of AKD in children.
  • Pediatric AKD is associated with substantial mortality (18.5%) and a high risk of progressing to chronic kidney disease (16% at 90 days).
  • KRT requirement is a critical factor predicting reduced kidney survival in pediatric AKD.
Abstract

Keywords:
Acute kidney diseaseEtiologyKidney survivalMortalityPediatricRisk factors

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