Acute Kidney Injury Is Common in Pediatric Severe Malaria and Is Associated With Increased Mortality

作者：Conroy Andrea L; Hawkes Michael; Elphinstone Robyn E; Morgan Catherine; Hermann Laura; Barker Kevin R; Namasopo Sophie; Opoka Robert O; John Chandy C; Liles W Conrad; Kain Kevin C

来源：Open Forum Infectious Diseases, 2016, 3(2): ofw046.

DOI：10.1093/ofid/ofw046

<jats:title>Abstract</jats:title>
<jats:p>Background.  Acute kidney injury (AKI) is a well recognized complication of severe malaria in adults, but the incidence and clinical importance of AKI in pediatric severe malaria (SM) is not well documented.</jats:p>
<jats:p>Methods.  One hundred eighty children aged 1 to 10 years with SM were enrolled between 2011 and 2013 in Uganda. Kidney function was monitored daily for 4 days using serum creatinine (Cr). Acute kidney injury was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Blood urea nitrogen (BUN) and Cr were assessed using i-STAT, and cystatin C (CysC) was measured by enzyme-linked immunosorbent assay.</jats:p>
<jats:p>Results.  Eighty-one (45.5%) children had KDIGO-defined AKI in the study: 42 (51.9%) stage 1, 18 (22.2%) stage 2, and 21 (25.9%) stage 3. Acute kidney injury evolved or developed in 50% of children after admission of hospital. There was an increased risk of AKI in children randomized to inhaled nitric oxide (iNO), with 47 (54.0%) of children in the iNO arm developing AKI compared with 34 (37.4%) in the placebo arm (relative risk, 1.36; 95% confidence interval [CI], 1.03–1.80). Duration of hospitalization increased across stages of AKI (P = .002). Acute kidney injury was associated with neurodisability at discharge in the children receiving placebo (25% in children with AKI vs 1.9% in children with no AKI, P = .002). Mortality increased across stages of AKI (P = .006) in the placebo arm, reaching 37.5% in stage 3 AKI. Acute kidney injury was not associated with neurodisability or mortality at discharge in children receiving iNO (P &amp;gt; .05 for both). Levels of kidney biomarkers were predictive of mortality with areas under the curves (AUCs) of 0.80 (95% CI, .65–.95; P = .006) and 0.72 (95% CI, .57–.87; P &amp;lt; .001), respectively. Admission levels of CysC and BUN were elevated in children who died by 6 months (P &amp;lt; .0001 and P = .009, respectively).</jats:p>
<jats:p>Conclusions.  Acute kidney injury is an underrecognized complication in young children with SM and is associated with increased mortality.</jats:p>

• 出版日期2016