THE FREQUENCY AND CLINICAL – LABORATORY MANIFESTATIONS OF ACUTE KIDNEY INJURY IN CHILDREN

Introduction. Acute kidney injury in childhood is an actual issue due to its multiple causes, severity, and high risk of progression to chronic kidney disease. We can see that there is growing evidence of аcute kidney injury among children, because it is associated with high morbidity and mortality. It is a common condition in pediatric intensive care units, varying from 10 % to 35 % of cases. Recently, this problem has become increasingly important not only medically but also socially.

Objective: To study the incidence of аcute kidney injury and its clinical and laboratory manifestations in children aged 1 to 17 years.

Methods and Materials: This single-center retrospective study included 56 children aged 1 to 17 years with established acute kidney injury. The analysis was conducted using pediatric inpatient records from the Nephrology Department and the Intensive Care Unit of Children's City Clinical Hospital No. 2 in Almaty, from January 2022 to December 2023.

Results. Acute kidney injury in 56 children was classified according to KDIGO (2012) as stage 0 in 17.8 % (10), stage 1 in 30.5 % (17), stage 2 in 12.5 % (7), and stage 3 in 39.2 % (22). The following main clinical and laboratory manifestations of acute kidney injury were identified: edema syndrome (37.5 %), predominantly localized to the lower extremities (62 %); hypertension syndrome (35.7 %); increased creatinine; decreased glomerular filtration rate; hyperazotemia; increased C-reactive protein; proteinuria; and leukocyturia.

Conclusions. For the early detection of acute kidney injury and timely assessment of the severity of children's condition, it is recommended to use the Kidney Disease: Improving Global Outcomes classification (2012). Children who have had an episode of acute kidney injury stages 1, 2, and 3 should be considered at group risk for developing chronic kidney disease.

1. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. (2012). KDIGO clinical practice guideline for acute kidney injury. Kidney International Supplements, 2(1), 1-138. DOI: https://doi.org/10.1038/kisup.2012.1.

2. Kaddourah, A., Basu, R. K., Bagshaw, S. M., & Goldstein, S. L. (2017). Epidemiology of acute kidney injury in critically ill children and young adults. New England Journal of Medicine, 376, 11-20. DOI: https://doi.org/10.1056/NEJMoa1611391.

3. Madsen, N. L., Goldstein, S. L., Froslev, T., Christiansen, C. F., & Olsen, M. (2017). Cardiac surgery in patients with congenital heart disease is associated with acute kidney injury and the risk of chronic kidney disease. Kidney International, 92, 751-756. DOI: https://doi.org/10.1016/j.kint.2017.03.033.

4. Benisty, K., Morgan, C., Hessey, E., Huynh, L., Joffe, A. R., Garros, D., et al. (2020). Kidney and blood pressure abnormalities 6 years after acute kidney injury in critically ill children: A prospective cohort study. Pediatric Research. DOI: https://doi.org/10.1038/s41390-020-01186-4.

5. Cho, M. H. (2020). Pediatric acute kidney injury: Focusing on diagnosis and management. Child Kidney Diseases, 24(1), 19-26. DOI: https://doi.org/10.3339/chikd.2020.24.1.19.

6. Hessey, E., Melhem, N., Alobaidi, R., Ulrich, E., Morgan, C., Bagshaw, S. M., & Sinha, M. D. (2021). Acute kidney injury in critically ill children is not all acute: Lessons over the last 5 years. Frontiers in Pediatrics, 9, 648587. DOI: https://doi.org/10.3389/fped.2021.648587.

7. Khandelwal, P., McLean, N., & Menon, S. (2022). Update on pediatric acute kidney injury. Pediatric Clinics of North America, 69(6), 1219-1238. DOI: https://doi.org/10.1016/j.pcl.2022.07.005.

8. Rivetti, G., Gizzone, P., Petrone, D., Di Sessa, A., Miraglia del Giudice, E., Guarino, S., & Marzuillo, P. (2024). Acute kidney injury in children: A focus for the general pediatrician. Children, 11, 1004. DOI: https://doi.org/10.3390/children11091004.

9. Plumb, L., Casula, A., Sinha, M. D., Inward, C. D., Marks, S. D., Medcalf, J., & Nitsch, D. (2023). Epidemiology of childhood acute kidney injury in England using e-alerts. Clinical Kidney Journal, 16, 1288-1297. https://doi.org/10.1093/ckj/sfad006 DOI:

10. Tai, C. W., Gibbons, K., Schibler, A., Schlapbach, L. J., & Raman, S. (2022). Acute kidney injury: Epidemiology and course in critically ill children. Journal of Nephrology, 35, 559-565. DOI: https://doi.org/10.1007/s40620-021-01169-0.

11. Lima Ruas, A. F., Lébeis, G. M., de Castro, N. B., Palmeira, V. A., Costa, L. B., Lanza, K., & Simões Silva, A. C. (2022). Acute kidney injury in pediatrics: An overview focusing on pathophysiology. Pediatric Nephrology, 37, 2037-2052. DOI: https://doi.org/10.1007/s00467-022-05552-y.

12. Roy, J. P., & Devarajan, P. (2020). Acute kidney injury: Diagnosis and management. Indian Journal of Pediatrics, 87, 600-607. DOI: https://doi.org/10.1007/s12098-020-03244-6.

13. Cho, M. H. (2020). Острое повреждение почек у детей: фокус на диагностике и лечении. Child Kidney Diseases, 24, 19-26. DOI: https://doi.org/10.3339/chikd.2020.24.1.19.

14. Askenazi, D. J., Feig, D. I., Graham, N. M., Hui-Stickle, S., & Goldstein, S. L. (2006). 3-5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney International, 69(1), 184-189. DOI: https://doi.org/10.1038/sj.ki.5000032.

15. Andreoli, S. P. (2009). Acute kidney injury in children. Pediatric Nephrology, 24(2), 253-263. DOI: https://doi.org/10.1007/s00467-008-1066-1.

16. Greenberg, J. H., Zappitelli, M., Devarajan, P., et al. (2008). Pediatric AKI epidemiology and pathophysiology. Seminars in Nephrology, 28(6), 436-446. DOI: https://doi.org/10.1016/j.semnephrol.2008.07.007.

17. Mishra, J., Dent, C., Tarabishi, R., et al. (2005). Neutrophil gelatinase–associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. The Lancet, 365(9466), 1231-1238. DOI: https://doi.org/10.1016/S0140-6736(05)74811-X.

18. Sutherland, S. M., Byrnes, J. J., Kothari, M., Longhurst, C. A., Dutta, S., & Garcia, P. (2015). AKI in hospitalized children: Comparing the pRIFLE, AKIN, and KDIGO definitions. Clinical Journal of the American Society of Nephrology, 10(4), 554-561. DOI: https://doi.org/10.2215/CJN.01900214.

19. Selewski, D. T., Cornell, T. T., Lombel, R. M., et al. (2012). Baseline characteristics and mortality risk in pediatric patients with acute kidney injury. Kidney International, 81(9), 819-826. DOI: https://doi.org/10.1038/ki.2011.445.