Kidney Res Clin Pract.  2018 Dec;37(4):347-355. 10.23876/j.krcp.18.0098.

Acute kidney injury in childhood-onset nephrotic syndrome: Incidence and risk factors in hospitalized patients

• Kim MY
• Cho MH
• Kim JH
• Ahn YH
• Choi HJ
• Ha IS
• Cheong HI
• Kang HG

• KMID: 2447179
• DOI: http://doi.org/10.23876/j.krcp.18.0098

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.

Keyword

Acute kidney injury; Child; Methylprednisolone; Nephrotic syndrome

MeSH Terms

Acute Kidney Injury*
Child
Cyclosporine
Dehydration
Hospitalization
Humans
Incidence*
Kidney Diseases
Korea
Methylprednisolone
Necrosis
Nephritis, Interstitial
Nephrotic Syndrome*
Renin-Angiotensin System
Retrospective Studies
Risk Factors*
Cyclosporine
Methylprednisolone