Comparison of profile and short-term outcome of acute kidney injury between steroid sensitive and steroid resistant nephrotic syndrome
DOI:
https://doi.org/10.18203/2349-3291.ijcp20231406Keywords:
NS, AKI, Short term outcome of SRNSAbstract
Background: Acute kidney injury (AKI), a severe complication of nephrotic syndrome (NS) is being more prevalent in recent times. Objectives were: 1) Determine incidence, etiology, short term outcome of AKI in children hospitalised with NS. 2) Compare above variables in steroid sensitive nephrotic syndrome (SSNS) versus steroid resistant nephrotic syndrome (SRNS).
Methods: Prospective observational study over 18 months including all consecutive nephrotics hospitalized with AKI. AKI defined according to KDIGO criteria with baseline creatinine taken as lowest value in last 6 months/ nadir during stay. Secondary NS were excluded. Demographics, clinical features, labs, hospital course, treatment and follow up at 3 months were recorded. SSNS and SRNS were compared.
Results: The incidence of AKI in hospitalised nephrotics (30/304) was 9.8%, 30 patients (16 boys) with mean age 4.08 years (± 4.04 SD). Common etiologies of AKI were infection (60%), nephrotoxic drugs, hypovolemia, and thrombosis in decreasing order. Nephrotics developing AKI had a longer hospital stay versus those without AKI (p<0.001). The 2/30 patients died (6%), 10/30 (33.3%) required PICU, 7/30 (26%) needed RRT. Among discharged patients 4/28(14.28%) had persistent deranged renal functions at 3 months follow up, all of whom belonged to SRNS category. Comparison of 14 patients in SSNS with 16 in SRNS showed UTI (31.3%), drugs (25%), systemic infection (31.3%), thrombosis (12.5%) as etiologies in SRNS. Systemic infection (42.9%), drugs (21.4%), UTI (14.3%) and hypovolemia (21.4%) were causes in SSNS. Mortality rate, need for PICU (p=1.0), RRT (p=1.0) was similar (6%,37.5%, 25%) Vs (7%,28.5%, 21.4%).
Conclusions: AKI is seen in up to a tenth of children with NS equally in SSNS and SRNS. While etiology and severity of AKI in the 2 groups is similar, short-term outcome in SRNS is more ominous.
References
Avner ED, Harmon WE, Niaudet P, Yoshikawa N, Emma F, Goldstein SL. Pediatric Nephrology. 7th edition. 2016.
Lionaki S, Liapis G, Boletis JN. Pathogenesis and Management of Acute Kidney injury in patients with Nephrotic Syndrome due to Primary Glomerulopathies. Medicina (Kaunas). 2019;55(7):365.
Menon S. Acute kidney injury in nephrotic syndrome. Front Pediatr. 2018;6:428.
Sinha A, Bagga A. Clinical practice guidelines for nephrotic syndrome: consensus is emerging. Pediatr Nephrol. 2022;37:2975-84.
Vasudevan A, Thergaonkar R, Mantan M, Sharma J, Khandelwal P et al. Consensus guidelines on management of steroid resistant nephrotic syndrome. Indian Pediatr. 2021;58(7):650-66.
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int. 2012;2(S):1-138.
Moffett B, Goldstein SL. Acute Kidney Injury and Increasing Nephrotoxic Medication Exposure in Noncritically -ill children. Clin J Am Society Nephrol. 2011;6(4):856-63.
Sharma M, Mahanta A, Barman AK, Mahanta PJ. Acute Kidney injury in children with nephrotic syndrome: a single centre study. Clin Kidney J. 2018;11(5);655-58.
Rheault MN, Zhang L, Selewski DT, Kallash M, Tran CL. AKI in Children Hospitalized with Nephrotic Syndrome. Clin J Am Soc Nephrol. 2015;10(12):2110-8.
Prasad BS, Kumar M, Dabas A, Mishra KS. Profile of Acute Kidney Injury in Hospitalized Children with Idiopathic Nephrotic Syndrome. Indian Pediatr J. 2019;56:119-22.
Kushwaha S, Yadav M, Hari P, Meena J, Sinha A. Incidence and Determinants of Acute Kidney Injury in Patients with Nephrotic Syndrome. Asian J Pediatr Nephrol. 2019:2(2);75-81.
Yaseen A, Tresa V, Lanewala AA, Hashmi S, Ali I. Acute Kidney injury in idiopathic nephrotic syndrome of childhood is a major risk factor for the development of chronic kidney disease. Renal Failure. 2017;39(1):323-7.
Young KM, Myung HC, Ji HKYo HA, Hyun JC. Acute Kidney injury in childhood onset nephrotic syndrome: Incidence and risk factors in hospitalised patients. Kidney Res Clin Pract. 2018;37(4):347-55.
