Acute kidney injury in children with visceral leishmaniasis.
BACKGROUND
There is no comprehensive study about renal function in children with visceral leishmaniasis (VL). The aim of this study was to investigate the incidence of acute kidney injury (AKI) in children with VL using pRIFLE classification and to determine the risk factors for AKI.


METHODS
A retrospective cohort study was conducted with 146 patients younger than 14 years of age with VL diagnosis in one center located at the northeast of Brazil from December 2003 to 2010. AKI was evaluated by pediatric Risk, Injury, Failure, Loss, End-stage kidney disease (pRIFLE) criteria.


RESULTS
The mean age was 5 ± 4.0 years (range, 5 months to 14 years), and 53.4% were males. AKI was observed in 67 patients (45.9%). The distribution according to the pRIFLE criteria was as follows: risk 45 (67.2%), injury 21 (31.3%), and failure 1 (1.5%). Patients in the AKI group were significantly younger (P < 0.001) and had jaundice (P = 0.028) and secondary infections (P = 0.001) more often than non-AKI patients. The AKI group had a significantly lower serum sodium (P = 0.03), potassium (P = 0.009), serum albumin (P = 0.001), and elevated serum globulins (P = 0.04), and a more prolonged prothrombin time (P = 0.001) at admission. Independent risk factors for AKI were: secondary infections (OR: 3.65, 95% CI: 1.426-9.358, P = 0.007), serum albumin decrement (OR: 1.672, 95% CI: 1.065-2.114, P = 0.019 per each 1 mg dL(-1) serum albumin decrement), and high serum globulin (OR: 1.35, 95% CI: 1.031-1.779, P = 0.029 per each 1 mg dL(-1) serum globulin increment).


CONCLUSIONS
AKI is a frequent complication in children with VL. The risk factors for AKI were secondary infections, high serum globulin and low serum albumin.
Post-Graduate Program in Public Health, University of Fortaleza, Fortaleza, Ceará, Brazil. alexandreliborio@yahoo.com.br
Alexandre Braga
AB
Libório
Natália A
NA
Rocha
Michelle J C
MJ
Oliveira
Luiz F L G
LF
Franco
Graziela B R
GB
Aguiar
Rodrigo S
RS
Pimentel
Krasnalhia Lívia S
KL
Abreu
Geraldo B
GB
Silva
Elizabeth F
EF
Daher
D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000503:physiopathology; D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology; D007677:Kidney Function Tests; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D012712:Serum Globulins / Q000032:analysis
D012709:Serum Albumin; D012712:Serum Globulins