Lower albumin level and longer disease duration are risk factors of acute kidney injury in hospitalized children with ne
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ORIGINAL ARTICLE
Lower albumin level and longer disease duration are risk factors of acute kidney injury in hospitalized children with nephrotic syndrome Eun Mi Yang 1 & Kee Hwan Yoo 2 & Yo Han Ahn 3 & Seong Heon Kim 4 & Jung Won Lee 5 & Woo Yeong Chung 6 & Min Hyun Cho 7 & Kee Hyuck Kim 8 & Heeyeon Cho 9 & Mee Jeong Lee 10 & Jin-Soon Suh 11 & Hye Sun Hyun 12 & Jiwon M. Lee 13 & Myung Hyun Cho 14 & Ji Hyun Kim 15 & Il-Soo Ha 3,16 & Hae Il Cheong 3 & Hee Gyung Kang 3,16,17 Received: 1 April 2020 / Revised: 21 July 2020 / Accepted: 6 August 2020 # IPNA 2020
Abstract Background Children with nephrotic syndrome (NS) are at an increased risk of acute kidney injury (AKI) and the incidence of AKI in this population is reportedly increasing. This study aimed to investigate the incidence, clinical profiles, and risk factors of AKI in hospitalized children with NS through a nationwide study. Methods This retrospective multicenter study included 14 pediatric nephrology centers in Korea. From 2013 to 2017, a total of 814 patients with idiopathic NS were cared for at participating centers. Among them, 363 patients were hospitalized for NS and investigated in this study. Results A total of 363 children with NS were hospitalized 574 times. AKI occurred in 93 admissions (16.2%) of 89 patients: 30 (32.3%) stage 1; 24 (25.8%) stage 2; and 39 (41.9%) stage 3. Multivariate logistic regression analysis showed that longer disease duration, lower albumin level, and methylprednisolone pulse treatment were significantly associated with AKI development in hospitalized children with NS. AKI was associated with a longer hospital stay than non-AKI (median 10 vs. 7 days, P = 0.001). Among 93 admissions, 85 (91.4%) episodes recovered from AKI without complication, whereas 6 (6.5%) progressed to advanced chronic kidney disease (CKD). Conclusions AKI is not uncommon in hospitalized children with NS, and its incidence in this nationwide study was 16.2%. Risk factors for AKI in hospitalized children with NS include longer disease duration, lower albumin level, and methylprednisolone pulse therapy. Pediatric NS patients with these characteristics should be under more strict scrutiny for the occurrence of AKI.
Keywords Nephrotic syndrome . Acute kidney injury . Children . Hospitalization . Risk factors
Introduction Nephrotic syndrome (NS) is a common childhood chronic glomerular disorder, and more than two thirds of children have NS relapse. Patients with NS are at risk of serious complications, including infections, thromboembolism (TE), and acute kidney injury (AKI). Among these complications, AKI Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00467-020-04740-y) contains supplementary material, which is available to authorized users. * Hee Gyung Kang [email protected]; [email protected] Extended author information available on the last page of the article
has been under-recognized until recently [1, 2] and considered uncommon in children, compared to adults [3]. However, a recent study reported tha
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