Renal dysfunction in children with acute intestinal infections without the development of hemolytic-uremic syndrome
Authors:   Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, Moscow, Russian Federation, Grebenkina E.Yu. ,   Speransky Children’s hospital No 9, Moscow, Russian Federation, Chugunova O.L. ,   N.I.Pirogov Russian National Research Medical University, Moscow, Russian Federation, Muzyka A.D. ,   Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, Moscow, Russian Federation, Usenko D.V. ,   Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, Moscow, Russian Federation
Published: March 2024

Issues of nephrological complications of the acute period of acute intestinal infections (AII) are currently concentrated mainly on the problem of critical conditions associated with the development of hemolytic-uremic syndrome (HUS). Taking into account the introduction into clinical practice of new highly specific biological markers of acute kidney injury (AKI), which make it possible to diagnose this condition before the development of uremia, new prospects for the early diagnosis of AKI are opening up, which will allow timely modification of treatment tactics that prevent its progression to chronic kidney disease and reduce disability in patients, which is important at the present stage of development of pediatrics and infectious diseases. Objective. To assess the prevalence of AKI in children with moderate AII without the formation of HUS, as well as to asses the diagnostic significance of modern biological markers of kidney damage. Patients and methods. 270 patients aged 1 to 7 years with moderate AII without the development of HUS (study group), as well as 55 somatic healthy children (comparison group) were examined. Over time, standard laboratory and instrumental studies were carried out, assessment of the levels of biomarkers of structural kidney damage (lipocalin-2, cystatin C, acute kidney injury molecules-1 (KIM-1)), as well as calculation of glomerular filtration rate using various formulas. Results. It was found that upon admission, 38% of children in the main group had reduced diuresis, 13% had an increase in serum creatinine levels, while the urea level was increased in only 3% of children. When assessing the level of AKI markers in patients with AII upon admission, an increase in the level of KIM-1 in the urine was detected in 90% of patients, cystatin C and lipocalin-2 in the blood serum in 18.9% of patients. A comprehensive assessment of identified renal dysfunction (based on decreased diuresis, increased serum creatinine, decreased glomerular filtration rate) in AEI without the development of HUS made it possible to diagnose the development of AKI in 13.7%, predominantly (in 97.3% of cases) – 1th stage according to KDIGO. Among the factors of unfavorable premorbid background in children of the main group who developed AKI, anemia (in 62.2% of patients) suffered during the last 6 months was significantly more common. AII (51.4%) and SARS (51.4%) (p < 0.001). Conclusion. With moderate AII in children, the development of AKI is registered in 13.7% of cases. Clinical factors associated with the development of AKI are: febrile fever lasting 4–6 days, degree II exacerbation, repeated vomiting lasting more than 3 days, diarrhea lasting 5–8 days, and the predominance of viral etiology of the disease. In order to optimize the diagnosis of AKI in children with AII, it is advisable to include in the examination plan the determination of the level of cystatin C and lipocalin-2 in the blood serum, which have a significantly higher sensitivity (94.6 and 97.3%) and specificity (84.5 and 85.8% respectively) compared to creatinine levels. Key words: children, acute intestinal infection, acute kidney injury, cystatin C, lipocalin-2, NGAL, KIM-1