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Published on: February 2, 2021
Acute Kidney Injury in Rhabdomyolysis: A 5-Year Children's Hospital Network Study
Jamie M Pinto1,2, Gregory Ison1, Lora J Kasselman3
1Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ 07753, USA.
Insights
Rhabdomyolysis, a skeletal muscle injury, can lead to acute kidney injury (AKI) in children. Older age, myoglobinuria, and bicarbonate treatment were linked to AKI in this pediatric study.
Area of Science:
- Pediatric Nephrology
- Muscle Physiology
Background:
- Rhabdomyolysis is a serious skeletal muscle injury with potential for acute kidney injury (AKI).
- Understanding risk factors for AKI in pediatric rhabdomyolysis is crucial due to a lack of standardized treatment guidelines.
Purpose of the Study:
- To investigate factors associated with AKI in pediatric patients diagnosed with rhabdomyolysis.
- To explore the management strategies employed for pediatric rhabdomyolysis cases.
Main Methods:
- Retrospective review of medical records from a children's hospital network over a 5-year period.
- Analysis of 112 pediatric patients meeting inclusion criteria, comparing those with and without AKI.
Main Results:
- AKI incidence was 7.1% (n=8), exclusively in patients with exertional rhabdomyolysis.
- Patients with AKI were significantly older (mean age 17 vs 13.3 years) and more likely to have myoglobinuria and receive intravenous bicarbonate.
- Older age (OR=1.44), myoglobinuria (OR=22.98), and intravenous bicarbonate (OR=16.02) were associated with AKI.
Conclusions:
- Acute kidney injury is uncommon in pediatric rhabdomyolysis but associated with older age, myoglobinuria, and bicarbonate administration.
- Further large-scale prospective studies are necessary to elucidate AKI risk factors and optimize treatment protocols for pediatric rhabdomyolysis.
Abstract:
Rhabdomyolysis is a skeletal muscle injury that can cause myoglobinuria and acute kidney injury (AKI). Risk factors for AKI in children are not clearly understood with no standardized treatment guidelines for rhabdomyolysis. Our study explores factors associated with AKI and management of pediatric patients with rhabdomyolysis. Medical records from a children's hospital network over a 5-year period were retrospectively reviewed. The results are described with respect to the presence or absence of AKI. Of the 112 patients who met the inclusion criteria, AKI incidence was 7.1% (n = 8), with all affected patients having exertional etiology. The overall mean age was 13.5 years; patients without AKI were younger than patients with AKI (13.3 versus 17; p < 0.001). Using regression models for hypothesis generation, we found that patients with AKI were more likely to be older (OR = 1.44, 95%CI [1.11-2.19]; p = 0.03), have myoglobinuria (OR = 22.98, 95%CI [2.05-432.48]; p = 0.02), and have received intravenous bicarbonate (OR = 16.02, 95%CI [1.44-228.69]; p = 0.03). In our study, AKI was uncommon and associated with older age, myoglobinuria and bicarbonate treatment. Larger, prospective studies are needed to further understand AKI risk factors and optimal management of pediatric rhabdomyolysis.
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