Acute Kidney Injury In Children Admitted In Pediatric Intensive Care Unit

: Background: Acute kidney injury (AKI) poses a significant burden for the society, in terms of health resource use during the acute phase, and the potential long-term sequelae including development of chronic kidney disease and kidney failure. Aim of the work: to investigate the risk of development of AKI in critically ill children. Material and methods: A cohort study conducted on 60 critically ill children admitted at pediatric intensive care unit (PICU). They were divided into two groups according to hemodynamic stability. Cardiovascular parameters together with criteria for AKI were observed during the first 5 days of PICU admission. AKI was diagnosed based on Acute Kidney Injury Network criteria. Results: From all critically ill included patients (60 patients); thirty four patients developed AKI (56.6%). Frequency of AKI was significantly more in hemodynamically unstable than stable patients 22 (73%) versus 12 (40%) (p=0.018). AKI was strongly associated with decreased baseline systolic and diastolic blood pressure percentiles (p=0.04) and (p=0.049), increased doses and duration of inotropic support determined by vasoactive inotropic score (p=0.002) and (p=0.013) respectively, higher base deficit in baseline blood gases (p=0.002), multiple organ dysfunctions (p<0.001) and exposure to nephrotoxic agents (p=0.036). Conclusion: AKI is a common morbidity among hemodynamically unstable critically ill children. AKI is strongly associated with initial hypotension on admission, increased doses and longer duration of inotropic support, increased base deficit in initial blood gases evaluation, multiple organ dysfunctions and exposure to nephrotoxic agents. CNS: nervous CVP: venous pressure; diastolic arterial blood pressure; ICU: intensive care INR: International normalized ratio; IQR: inter-quartile range; MAP: mean arterial blood pressure; mechanical ventilation; PC: prothrombin concentration; PICU: pediatric intensive care unit; PT: prothrombin time; ROC: receiver operating characteristic RRT: renal replacement therapy; SBP: systolic arterial pressure; ScvO2: central venous oxygenation saturation; SD: standard deviation; SV: volume; SVR: systemic vascular resistance; SVRI: systemic vascular resistive index; SVV: stroke volume variability; TFC: thoracic fluid content; UOP: urine output; VIS: vasoactive inotropic score. The current cohort study aimed to investigate the association between systemic hemodynamic indices and the risk of development or progression of AKI in 60 critically ill children. Thirty four patients (56%) developed AKI. The percent of patients who developed AKI in the hemodynamically unstable group was significantly higher than that in stable group (73.3% versus 40% with p=0.018). Our rate of AKI among critically ill children is similar to others; who reported AKI in (50.3%) of the patients upon PICU admission based on AKIN criteria ( 23 ). On the other hand; lower incidence was reported in a large multinational study of the epidemiology of AKI in children and young adults in ICU. They found that AKI occurred in one quarter of patients during the first 7 days after ICU admission ( 25 ). This variation probably results from differences in case mix, illness severity, coexisting conditions, and definitions of AKI. risk 26 , 27 ). The discrepancy between our results and previous reports could be explained by the wide age range of our studied patients.