Acute kidney injury in childhood-onset nephrotic syndrome: Incidence and risk factors in hospitalized patients
김미영, 조명현, 김지현, 안요한, 최현진, 하일수, 정해일, 강희경,
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김미영 ( Kim Mi-Young )
Seoul National University Hospital Department of Pediatrics
조명현 ( Cho Myung-Hyun )
Seoul National University Hospital Department of Pediatrics
김지현 ( Kim Ji-Hyun )
Seoul National University Hospital Department of Pediatrics
안요한 ( Ahn Yo-Han )
Seoul National University College of Medicine Department of Pediatrics
최현진 ( Choi Hyun-Jin )
Seoul National University Hospital Department of Pediatrics
하일수 ( Ha Il-Soo )
Seoul National University Hospital Department of Pediatrics
정해일 ( Cheong Hae-Il )
Seoul National University Hospital Department of Pediatrics
강희경 ( Kang Hee-Gyung )
Seoul National University Hospital Department of Pediatrics
Abstract
Background: Nephrotic syndrome (NS) is the most common glomerulopathy in children. Acute kidney injury (AKI) is a common complication of NS, caused by severe intravascular volume depletion, acute tubular necrosis, interstitial nephritis, or progression of NS. However, the incidence and risk factors of childhood-onset NS in Korea are unclear. Therefore, we studied the incidence, causes, and risk factors of AKI in hospitalized Korean patients with childhood-onset NS.
Methods: We conducted a retrospective review of patients with childhood-onset NS who were admitted to our center from January 2015 to July 2017. Patients with decreased renal function or hereditary/secondary NS, as well as those admitted for management of other conditions unrelated to NS, were excluded.
Results: During the study period, 65 patients with idiopathic, childhood-onset NS were hospitalized 90 times for management of NS or its complications. Of these 90 cases, 29 met the Kidney Disease Improving Global Outcomes criteria for AKI (32.2%). They developed AKI in association with infection (n = 12), NS aggravation (n = 11), dehydration (n = 3), and intravenous methylprednisolone administration (n = 3). Age ≥ 9 years at admission and combined use of cyclosporine and renin-angiotensin system inhibitors were risk factors for AKI.
Conclusion: AKI occurred in one-third of the total hospitalizations related to childhood-onset NS, owing to infection, aggravation of NS, dehydration, and possibly high-dose methylprednisolone treatment. Age at admission and use of nephrotoxic agents were associated with AKI. As the AKI incidence is high, AKI should be considered during management of high-risk patients.
키워드
Acute kidney injury; Child; Methylprednisolone; Nephrotic syndrome
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