Çocuklarda Akut Böbrek Hasarı Sonrası Uzun Dönem Böbrek Fonksiyonları

Abstract

Amaç: Geçirilmiş Akut Böbrek Hasarı (ABH) atağının kronik böbrek hastalığı gibi uzun vadeli sonuçları olduğu yaygın olarak kabul edilmektedir. Ancak ABH atağından sonra gelişen böbrek fonksiyonlarındaki bozulma için risk faktörleri pediatrik yaş grubunda iyi tanımlanmamıştır. Bu çalışmanın amacı, hastane yatışlarında ABH atağından geçen çocukların 1. ve 5. yıl böbrek fonksiyonlarını değerlendirmek ve böbrek fonksiyonlarını etkileyen risk faktörlerini belirlemektir.

Gereç ve Yöntemler: 2008-2012 yılları arasında ABH atağı geçiren 219 hasta çalışmaya dâhil edildi. 62 hasta 1 yıldan az yaşadı. Geriye kalan 157 hastanın 1. ve 5. yıldaki serum kreatinin konsantrasyonları geriye dönük olarak incelendi.

Bulgular: ABH atağı sırasında ≤2 yaş olan ve Yetmezlik + Kayıp grubunda olan hastaların ABH sonrası birinci ve beşinci yıllardaki hesaplanmış Glomerular Filtrasyon Hızı (hGFH) değerleri ABH atağı sırasında > 2 yaş olan ve Risk + Hasar grubunda olan hastalara göre anlamlı olarak daha düşüktü. Hastaların % 25.7’sinde ve % 40.3’ünde ABH sonrası sırasıyla 1. ve 5. yılda düşük hGFH vardı. Lojistik regresyon modelinde, ABH’dan sonraki 1. ve 5. yılda düşük hGFH’ya sahip olmakla ilişkili faktörler küçük yaşta ABH atağı geçirmek olarak bulundu; fakat ABH’nın derecesi düşük hGFH’nı etkilemiyordu.

Sonuç: Geçirilmiş ABH atağı, çocuklarda uzun dönem böbrek fonksiyonlarını olumsuz yönde etkileyebilir. ABH atağı sırasında infant yaş grubunda olmak ve ileri ABH evresine sahip olmak, uzun dönemde, kötü böbrek fonksiyonları ile ilişkilidir.

Keywords

• Akut Böbrek Hasarı
• Çocuk
• Kronik Böbrek Hastalığı
• Akut Böbrek Yetmezliği
• Pediatri
• Renal Fonksiyon

The Long-Term Renal Functions After An Episode of Acute Kidney Injury in Children

Abstract

Objective: It is widely accepted that an acute kidney injury (AKI) episode has long-term consequences such as chronic kidney disease. But the risk factors for poor renal outcome after an AKI episode are not well defined in paediatric age group. The aim of this study is to evaluate the first and fifth-year renal functions of the patients who undergo AKI during their hospital admission and to determine the risk factors affecting renal functions.

Material and Methods: 219 patients who underwent AKI from 2008 to 2012 were included in this study. 62 patients survived less than 1 year. The first and the fifth-year serum creatinine concentrations of the remaining 157 patients were reviewed retrospectively.

Results: Patients who were ≤2 years of age and patients who were in Failure+Loss group at the time of AKI had significantly lower estimated Glomerular Filtration Rate (eGFR) values in the first and fifth year after AKI compared to patients who were>2 years of age and patients who were in Risk+Injury group. 25.7% and 40.3% of the patients had abnormal eGFR in the first and fifth year after AKI respectively. In a logistic regression model, factors associated with having abnormal eGFR in the first and fifth year after AKI included younger age but not an advanced degree of AKI.

Conclusion: The previous episode of AKI could cause harmful effects on renal functions of children in the long term. Younger age and advanced stage of AKI are associated with worse renal functions after an episode of AKI.

Keywords

• Acute Kidney Injury
• Chronic Kidney Disease
• Acute Renal Failure
• Paediatrics
• Renal Function

References

1. 1. Vachvanichsanong P, Dissaneewate P, Lim A, McNeil E. Childhood acute renal failure: 22-year experience in a university hospital in southern Thailand. Pediatrics. 2006;118:e786-e91. 2. Greenberg JH, Coca S, Parikh CR. Long-term risk of chronic kidney disease and mortality in children after acute kidney injury: a systematic review. BMC Nephrol. 2014;15:184-94. 3. Hui-Stickle S, Brewer ED, Goldstein SL. Pediatric ARF epidemiology at a tertiary care center from 1999 to 2001. Am J Kidney Dis. 2005;45:96-101. 4. Imani PD, Odiit A, Hingorani SR, Weiss NS, Eddy AA. Acute kidney injury and its association with in-hospital mortality among children with acute infections. Pediatr Nephrol. 2013;28:2199-206. 5. Sutherland SM, Ji J, Sheikhi FH, Widen E, Tian L, Alexander SR, et al. AKI in hospitalized children: epidemiology and clinical associations in a national cohort. Clin J Am Soc Nephrol. 2013;8:1661-9. 6. Goldstein SL, Devarajan P. Pediatrics: acute kidney injury leads to pediatric patient mortality. Nat Rev Nephrol. 2010;6:393-4. 7. Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL. Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med. 2017;376:11-20. 8. Askenazi D, Feig D, Graham N, Hui-Stickle S, Goldstein S. 3–5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int. 2006;69:184-9. 9. Goldstein SL. Acute kidney injury in children and its potential consequences in adulthood. Blood Purif. 2012;33:131-7. 10. Mammen C, Al Abbas A, Skippen P, Nadel H, Levine D, Collet J, et al. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis. 2012;59:523-30. 11. Chawla LS, Eggers PW, Star RA, Kimmel PL. Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med. 2014;371:58-66. 12. Akcan-Arikan A, Zappitelli M, Loftis L, Washburn K, Jefferson L, Goldstein S. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71:1028-35. 13. Pottel H, Hoste L, Martens F. A simple height-independent equation for estimating glomerular filtration rate in children. Pediatr Nephrol. 2012;27:973-9. 14. Loza R, Estremadoyro L, Loza C, Cieza J. Factors associated with mortality in acute renal failure (ARF) in children. Pediatr Nephrol. 2006;21:106-9. 15. Oztek‐Celebi FZ, Ozlu SG, Aydog O. Factors that influenced undergoing renal replacement therapy and survival in children with acute kidney injury. Nephrology. 2019;24:181-7. 16. Harer MW, Pope CF, Conaway MR, Charlton JR. Follow-up of Acute kidney injury in Neonates during Childhood Years (FANCY): a prospective cohort study. Pediatr Nephrol. 2017;32:1067-76. 17. Chaturvedi S, Ng KH, Mammen C. The path to chronic kidney disease following acute kidney injury: a neonatal perspective. Pediatr Nephrol. 2017;32:227-41. 18. Luyckx VA, Bertram JF, Brenner BM, Fall C, Hoy WE, Ozanne SE, et al. Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease. Lancet. 2013;382:273-83. 19. Weight TLB, Group NNW. The impact of kidney development on the life course: a consensus document for action. Nephron. 2017;136:3-49. 20. Chawla LS, Amdur RL, Amodeo S, Kimmel PL, Palant CE. The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int. 2011;79:1361-9. 21. Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int. 2012;81:442-8. 22. Heung M, Chawla LS. Predicting progression to chronic kidney disease after recovery from acute kidney injury. Curr Opin Nephrol Hypertens. 2012;21:628-34. 23. Al-Otaibi NG, Zeinelabdin M, Shalaby MA, Khathlan N, Mashat GD, Zahrani AA, et al. Impact of acute kidney injury on long-term mortality and progression to chronic kidney disease among critically ill children. Saudi Med J. 2017;38:138-42. 24. Kirwan CJ, Blunden MJ, Dobbie H, James A, Nedungadi A, Prowle JR. Critically ill patients requiring acute renal replacement therapy are at an increased risk of long-term renal dysfunction, but rarely receive specialist nephrology follow-up. Nephron. 2015;129:164-70.