Clinical Analysis Of223Cases With Acute Kidney Injury

PART ONE COMPARATIVE ANALYSIS OFDIAGNOSTIC VALUE OF AKI AND ARFObjective To investigate diagnostic value of AKI and ARF in clinicalpractice.Methods Clinical data of223cases with AKI in Children’s hospitalAffiliated to Chongqing Medical University from January2011toDecember2011.Divided the patients into2groups：group ARF and groupnon-ARF, To comparative analysis age distribution，etiology distribution，clinical feature and prognosis.Results AKIN classification was available for223patients,including89cases ARF（39.9%） and134casenon-A RF （60.1%）.There was no statistically significant difference in sexdistribution， age distribution，etiology distribution and clinical feature ofthe two group. Although the prognosis was better in group non-ARF thanARF. The rate of not cured patients and mortality was still high in groupnon-ARF. There was no significant difference in hospital stays of two group.Conclusion Diagnosis of ARF was easy to misdiagnosis of somepatients who had kidney damage，and lead to delay treatment. Diagnosis ofAKI can early identification， early intervention and improve the curativeeffect of those patients. PART TWO CLINICAL CHARACTERISTICS ANDPROGNOSIS OF223CHILDREN WITH ACUTE KIDNEYINJURYObjective To investigate the etiology，clinical manifestations，laboratory features,treatment and prognostic factors of acute kidney injury（AKI）inpediatricpatients，infavorofearlydetection，earlypreventionand better curative effects of the disease.Methods Clinical data of223cases with AKI in Children’s hospitalAffiliated to Chongqing Medical University from January2011to December2011，including the causes, clinical features, laboratory features, renalpathological findings, treatment and outcome, were retrospectively analyzed.The relationship between the risk factors and prognosis was analyzed.Results AKIN classification was available for223patients, including151male and72female. Median age at the time of AKI was3years and9months old (range1day~16years and2months old). The average hospitalstays was (12.98±9.99)d. The mortality rate was6.7%.79patients withpre-renal AKI mainly caused by infection and hypoxic-ischemic injury.Theetiology of139cases of renal parenchymal AKI mostly was nephroticsyndrome and acute poststreptococcal glomerulonephritis.The etiology of5cases of post-renal AKI was urinary calculus. The causes of AKI weredifferent among the distinct age groups(χ2=119.771P＜0.05). Infants were prone to prerenal AKI, toddlers pre-school years and school age childrenwere prone to renal parenchymal AKI.Patients’ AKI was classifiedaccording to the staging system as following: stage1was45cases(20.2%),stage2was59cases(26.5%) and stage3was119cases(53.4%).There were70patients subjected to renal replacement therapy,theScr、BUN descended. The prognosis was statistically significant comparedwith patients without RRT (u=2.415，P<0.05). Univariate analysis revealedthat prognosis was correlated with etiology, AKI degree, mechanicalventilation, sepsis/septic shock, MODS, acidosis, first creatinine, peakcreatinine, serum potassium. Multivariate analysis showed that mechanicalventilation, MODS and sepsis/septic shock were independent risk factors fordeath.Conclusion Renal parenchymal factors was the most common causeof AKI. The etiology of AKI in children is diverse,there was significantdifference in etiology among different age groups. Renal replacementtherapy was a effective method of treatment in AKI. It showed that etiology,AKI degree, mechanical ventilation, sepsis/septic shock, MODS, acidosis,first creatinine, peak creatinine, serum potassium were correlated withprognosis. Multivariate analysis showed that mechanical ventilation, MODS,sepsis/septic shock were important risk factors of death. The early diagnosis and effective treatment can improve prognosis and rate of survivors.