What Are the Predictors of Acute Kidney Injury in Children Admitted to Pediatrics Intensive Care Unit at Assiut University Children Hospital?

Overview

Identify the Predictors of Acute Kidney Injury in critically ill children admitted to PICU during one year

Acute kidney injury (AKI) is defined by a sudden loss of excretory kidney function. AKI is part of a range of conditions summarized as acute kidney diseases and disorders (AKD), in which slow deterioration of kidney function or persistent kidney dysfunction is associated with an irreversible loss of kidney cells and nephrons, which can lead to chronic kidney disease AKI is determined by increased serum creatinine levels \>0.3 mg/dl (a marker of kidney excretory function) and reduced urinary output \<0.5 ml/Kg for more than 8 h (a quantitative marker of urine production) and is limited to a duration of 7 days and when lasts for\>3months is referred to as chronic kidney disease (CKD).Acute kidney injury (AKI) is associated with poor outcome in critically ill children.The reported incidence rate of AKI in children admitted to pediatric intensive care units (PICUs) ranges from 8% and 89% worldwide. Stage 1 was identified in 24.24% of the AKI cases, stage 2 in 31.03% and stage 3 in 44.71%. The most prevalent cause of AKI was represented by prerenal AKI in 85.64% of the cases, followed by 12.16% renal causes respectively 2.18% postrenal causes. Symptoms of an AKI come on suddenly, over the course of hours or days. They depend on the underlying cause, but some of the most common symptoms include hematuria, fever, rash, bloody diarrhea, severe vomiting, abdominal pain, no urine output or high urine output, pale skin. oedema, puffy eyes and detectable abdominal mass. stages of Acute Kidney Injury .A standardized definition of AKI was proposed by the Kidney Disease: ImprovIng Global Outcomes (KDIGO) AKI working group in 2012 and has been validated In pediatric populations subsequently. This definition identifies and stages AKI Based on changes in serum creatinine from baseline or urine output as detailed . Stage 1 Serum creatinine increase by 1.5-1.9 times baseline within 7 days or increase by ≥0.3 mg/dL (26.5 μmol/L) within 48 hours Urine output is less than 0.5 mL/kg/h for 6 - 12 hours Stage 2 Serum creatinine increase by 2-2.9 times baseline Urine output is less than 0.5 mLkg/h for \>12 hours Stage 3 Serum creatinine increase by ≥3 times baseline or increase to≥ 4 mg/dL (353.6 μmol/L) or renal replacement therapy initiation or in patients younger than 18 years decrease in estimated GFR to \<35 mL/min/1.73 m2 Urine output is less than 0.3 ml/kg/h for ≥24 h or anuria for ≥12h There are many predisposing factors that lead to AKI for such as gastroenteritis, presence of infection, sepsis, shock, cardiac disease, mechanical ventilation hypoxia and coagulopathy are important predictors for AKI. Despite significant developments in the management of AKI, the overall mortality rate of patients with AKI has not improved dramatically. The most widely available studies deal primarily with AKI, reporting mortality rates between 11% and 63% in pediatric patients. Outcomes among children who develop acute kidney injury (AKI). Children who develop AKI while hospitalized are at risk for poorer short-and mid/long-term outcomes. Across both acute and critical care populations, AKI is associated with longer lengths of stay, non-recovery of baseline renal function, and chronic renal disease including proteinuria hypertension, and chronic kidney disease (CKD).

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