Application of the new classification criteria of the Acute Kidney Injury Network: a pilot study in a pediatric populati
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ORIGINAL ARTICLE
Application of the new classification criteria of the Acute Kidney Injury Network: a pilot study in a pediatric population Z. Birsin Özçakar & Fatoş Yalçınkaya & Beril Altas & Hüseyin Ergün & Tanıl Kendirli & Can Ateş & Atilla H. Elhan & Mesiha Ekim Received: 26 November 2008 / Revised: 12 February 2009 / Accepted: 16 February 2009 / Published online: 24 March 2009 # IPNA 2009
Abstract The purpose of our study was to apply the new classification criteria proposed by the Acute Kidney Injury Network (AKIN) in a pediatric population and to determine the clinical characteristics, laboratory features and outcomes of acute kidney injury (AKI) in a tertiary pediatric nephrology center in Turkey. Patients’ charts from January 2003 to August 2008 were retrospectively evaluated. One hundred patients (55 male; 45 female) were enrolled. Median age at the time of AKI was 7 years (range 1 month−18 years). Patients’ AKI was classified according to the staging system as follows: 25% stage 1, 36% stage 2 and 39% stage 3. The etiology of AKI was bone marrow transplantation related in 27%, renal disease in 14%, dehydration in 10%, nephrotoxic medication in 8%, cardiac surgery related in 8%, and congenital anomalies in 2%. Multiple etiologic factors with underlying chronic diseases were present in 31% of the patients. Dialysis was needed in 45% of the patients. Mortality rate was 33%. Dialysis need and mortality rate were higher in stage 2 and stage 3 patients, with a more favorable prognosis in stage 1 Z. B. Özçakar : F. Yalçınkaya : M. Ekim Division of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey B. Altas : H. Ergün : T. Kendirli Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey C. Ateş : A. H. Elhan Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
patients. Mortality rate was higher in patients that had undergone cardiac surgery and in those with multiple etiologic factors. The proposed AKIN staging successfully reflected the course of patients with AKI. The underlying cause of AKI seemed to be an important risk factor for death. Keywords Acute kidney injury . Children . Classification . Dialysis . Mortality rate
Introduction Acute kidney injury (AKI) is a common clinical problem characterized by acute decline in renal function with manifestations ranging from minimal elevation of serum creatinine concentration to anuric renal failure [1]. The etiology and management of AKI differ extensively from developing countries to developed countries [2–6]. These parameters differ, even in the same country, from one center to another, depending on the location, level, and resources of the center. Data concerning the etiology and management of AKI in children from developing countries have started to be reported recently [3–6]. Owing to the lack of common standards in its diagnosis and classification, the Acute Kidney Injury Network (AKIN) proposed a new classification for AKI [7]. The purpose of our study was to apply the new classi
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