The Clinical Features Of85Cases Of Children With Acute Kidney Injury

Objective:To investigate etiology, age, gender, clinical features, prognosis and influencingfactors in Children with acute kidney injury (AKI), and to detect the early predictivebiomarkers of AKI, so as to enhance the level of diagnosis and treatment of AKI, andimprove the prognosis of children with AKI.Methods:Retrospective analysis of85cases of children with AKI clinical data, analysis ofthe causes of AKI children and distribution characteristics, and discuss the clinicalmanifestation, laboratory examination, AKI stage and prognosis of relevance, at thesame time by using enzyme-linked immunosorbent assay (ELISA) detection in urineNGAL, IL-18and KIM-1level, three indicators evaluation value in early diagnosisof AKI.Result:1. Characteristic of patients with AKIEighty-five patients (48male,37female) were enrolled in the study, mean age8.7±3.9years old. The neonatal period,8cases, accounting for9.4%;Infancy,4cases(4.7%);Early childhood,10cases(11.8%),Preschool period of17cases (20.0%),School-age34cases (40.0%),Adolescence12cases, accounting for14.1%.Patients’AKI was classified according to the staging system as follows:67.1%stage1,20.0%stage2and12.9%stage3.2. Constitution of causesIn the distribution of the cause of prerenal of AKI25cases accounted for29.4%(25/85),renal51cases of AKI, accounting for60.0%(51/85),renal nature of AKI after,accounting for10.6%(9/85).The causes of AKI were different among the distinct agegroups. The main cause of neonates with AKI was prerenal AKI. The main cause ofinfancy and toddler children with AKI was postrenal AKI. Preschool and school-agechildren with AKI was renal parenchymal AKI. 3. Clinical outcomes28cases were cured,53cases were improved and4cases died among85casespatients with AKI. With renal AKI3cases died before sex, sexual AKI kidney in1case death, by AKI kidney before sex case fatality rate is highest, at3.5%.4. The prognostic risk factorsThere was no difference in age, sex, hematuria, serum electrolytes, GFR, serumalbumin or hospitalization days among each group. Univariate analysis revealed thatprognosis was correlated with high blood pressure, hemoglobin, platelet, course of thedisease, AKI stage and whether with oliguria or proteinuria. Multivariate analysisshowed that urine, high blood pressure, hemoglobin and proteinuria are the high riskfactors influencing the prognosis of children with AKI.5. The change of the early biological markersCompared with3days before diagnosis of AKI, urinary NGAL levels increasedsignificantly(P＜0.05), urinary IL-18, KIM-1and serum creatinin levels didn’tchange(P＞0.05)2days prior to the diagnosis of AKI. Urinary NGAL, IL-18andKIM-1levels increased significantly(P＜0.05), while the serum creatinine levels nosignificant change (P＞0.05)1days prior to the diagnosis of AKI. Urinary NGAL,IL-18, KIM-1and serum creatinin levels all increased significantly on the day of AKIdiagnosis(P＜0.05).Correlation analysis showed that the levels of urinary NGAL,IL-18and KIM-1were positively correlated with the levels of serum creatinine,correlation coefficients were0.446,0.509,0.815, respectively, P values＜0.05.Conclusion:The etiology of AKI in children is diverse, renal and prerenal are main causes,lead to the cause of AKI in single factor accounted for the vast majority. Theprognosis is corrected with AKI stage, high blood pressure, course of AKI,hemoglobin, platelet, whether with oliguria and proteinuria. Urine NGAL, IL-18and KIM-1for early diagnosis of AKI has predictive value, can be used as abiomarker in early diagnosis of AKI. It is important to diagnose AKI in the earlyphase.