DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20174749

Validation of Renal Angina Index (RAI) to improve the prediction of Acute Kidney Injury (AKI) in critically ill children admitted to paediatric intensive care unit (PICU)

Jakanattane V., Sivakumar E., Rajkumar D., Kulandaivel M.

Abstract


Background: Acute Kidney Injury (AKI) is associated with poor outcome in critically ill children. Reliable prediction of severe AKI may optimize treatment. Here we operationalize the concept of renal angina with Renal Angina Index (RAI). The objective of this study was to validate RAI for prediction of severe AKI on Day 3 of admission.

Methods: A prospective observational study including children 1 month to 12 years admitted to PICU at ICH and RC, Madurai over 6 months. Clinical data, urine output (ml/kg/hour), serial S. creatinine values were collected. Renal angina positive was defined as RAI score ≥8.

Results: Overall incidence of AKI was 27.8%. Day 0 RAI ≥8 was 42.9% of which 56.1% developed day 3 AKI. RAI ≤8 had high NPV of 93% for Day 3 AKI. Renal angina concept using RAI predicts subsequent severe AKI. RAI provides clinically feasible and applicable methodology to identify critically ill children at risk of severe AKI lasting beyond functional injury. RAI may potentially reduce capricious AKI biomarker use.

Conclusions: The use of renal angina to stratify patients for enrollment in biomarker or therapy trials may create the uniformity required to properly analyze AKI in pediatric population. We believe that renal angina is a clinical adjunct that will lead to the optimization of AKI biomarker performance across the wide-ranging heterogeneity that exists across the general pediatric PICU population. RAI may potentially reduce capricious AKI biomarker use by identifying patients in whom further testing would be most beneficial.


Keywords


AKI, PICU, Renal angina

Full Text:

PDF

References


Schneider J, Khemani R, Grushkin C, Bart R. Serum creatinine as stratified inthe RIFLE score for acute kidney injury is associated with mortality and1length of stay for children in the pediatric intensive care unit. Crit CareMed 2010;38:933-9.

Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71:1028-35.

Chertow GM, Burdick E, Honour M. Acute kidney injury, mortality,length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16:3365-70.

Zappitelli M, Bernier PL, Saczkowski RS. A small post-operative rise inserum creatinine predicts acute kidney injury in children undergoingcardiac surgery. Kidney Int. 2009;76:885-92.

Goldstein SL. Acute kidney injury biomarkers: renal angina and the needfor a renal troponin I. BMC Med. 2011;9:135.

Han WK, Waikar SS, Johnson A, Betensky RA, Dent CL, Devarajan P. Urinary biomarkers in the early diagnosis of acute kidney injury. Kidney Int. 2008;73:863-9.

Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet. 2005;365:1231-8.

Parikh CR, Mishra J, Thiessen-Philbrook H, Dursun B, Ma Q, Kelly C, et al. Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney Int. 2006;70:199-203.

Al-Ismaili Z, Palijan A, Zappitelli M. Biomarkers of acute kidney injury in children: discovery, evaluation, and clinical application. Pediatr Nephrol. 2011;26:29-40.

Ahlstrom A, Tallgren M, Peltonen S, Pettila V. Evolution and predictive power of serum cystatin C in acute renal failure. Clin Nephrol. 2004;62:344-50.

Coca SG, Yalavarthy R, Concato J, Parikh CR. Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review. Kidney Int. 2008;73:1008-16.

Simmons EM, Himmelfarb J, Sezer MT, Chertow GM, Mehta RL, Paganini EP, et al. Plasma cytokine levels predict mortality in patients with acute renal failure. Kidney Int. 2004;65:1357-65.

Zappitelli M, Washburn KK, Arikan AA, Loftis L, Ma Q, Devarajan P, et al. Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study. Crit Care. 2007;11:R84.

Basu RK, Chawla LS, Wheeler DS, Goldstein SL. Renal angina: an emerging paradigm to identify children at risk for acute kidney injury. Pediatr Nephrol. 2012;27:1067-78.

Goldstein SL, Chawla LS. Renal angina. Clin J Am Soc Nephrol. 2010;5:943-9.

Zappitelli M, Parikh CR, Akcan-Arikan A. Ascertainment and epidemiology of acute kidney injury varies with definition interpretation. Clin J Am SocNephrol. 2008;3:948-54.

Dellinger RP, Levy MM, Rhodes A. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580-637.

Group KW. Kidney disease improving global outcomes; clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:19-33.

Endre ZH, Kellum JA, Di Somma S. Differential diagnosis of AKI in clinical practice by functional and damage biomarkers workgroup statements from the tenth Acute Dialysis Quality Initiative Consensus Conference. Contrib Nephrol. 2013;182:30-44.

Han SS, Kang KJ, Kwon SJ. Additional role of urine output criterion in defining acute kidney injury. Nephrol Dial Transplant. 2012;27:161-5.