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Kidney Week

Abstract: FR-PO035

Prevalence, Risk Factors, and Prognosis of AKI in Pediatric Nephrotic Syndrome

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Yang, Eun mi, Chonnam National University Medical School , Gwangju, Korea (the Republic of)
  • Kim, Keehyuck, NHIS Ilsan Hospital, Goyang-shi, Korea (the Republic of)
  • Kim, Seong heon, Pusan National University Children's Hospital, Yangsan, Korea (the Republic of)
  • Suh, Jin-Soon, Bucheon St.Mary's Hospital, Catholic University, Bucheon-si, Gyeonggi-do, Korea (the Republic of)
  • Ahn, Yo Han, Seoul National University Bundang Hospital, Seongnam, KyungGi-DO, Korea (the Republic of)
  • Yoo, Kee Hwan, Korea University Guro Hospital, Seoul, Korea (the Republic of)
  • Lee, Jung won, Ewha Womans University, school of medicine, Seoul, Korea (the Republic of)
  • Cho, Min Hyun, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Cho, Heeyeon, Samsung Medical Center, Seoul, Korea (the Republic of)
  • Lee, Jiwon M., Chungnam National University, Seoul, Korea (the Republic of)
  • Ha, IL-Soo, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Cheong, Hae Il, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Kang, Hee Gyung, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
Background

Children with nephrotic syndrome (NS) are at an increased risk of severe infection, thrombosis, and acute kidney injury (AKI). In NS patients, AKI is associated with an increased risk of chronic kidney injury, and its incidence is increasing. Despite this, there is limited data regarding the epidemiology and risk factors of AKI in pediatric NS patients. Thus, the aim of this study was to investigate the incidence, clinical profiles, and risk factors of AKI in pediatric NS patients.

Methods

This was a retrospective multicenter study involving 14 pediatric nephrology centers. From 2013 to 2017, a total of 814 patients with idiopathic NS were reviewed, and 487 patients hospitalized for NS were analyzed.

Results

Among 363 children, 574 hospitalizations occurred. AKI occurred in 10.9% (89 patients) of the 814 children with NS and 16.2% of the 363 children who were hospitalized. Among the 588 cases of hospitalization, AKI was found in 93 (16.2%) cases: 30 (33.3%) had stage 1 AKI; 24 (25.8%), stage 2 AKI; and 39 (41.9%), stage 3 AKI. Refractory NS was the major predisposing factor for AKI in 26 (28.0%) cases. Pediatric NS patients with AKI were older; had a longer disease duration, steroid resistance, and a lower serum albumin level; and were administering of calcineurin inhibitors. Logistic regression analysis revealed that longer disease duration, lower albumin level, and steroid resistance were significantly associated with the development of AKI in pediatric NS patients. AKI was associated with a longer length of hospital stay (median duration, 10 days compared to 7 days for hospitalized patients without AKI; P = 0.001). A total of 84 (90.3%) children recovered from AKI, whereas 6 (6.5%) developed chronic kidney injury, and 3 children had neurologic sequelae related to an accompanying infection.

Conclusion

AKI, often leading to chronic kidney injury, is common in children who are hospitalized with NS. Risk factors for AKI include a longer disease duration, steroid-resistance, and infection; these can be potential tools in the recognition and management of AKI in children with NS.