Acute kidney injury in a single pediatric intensive care unit in Poland: a retrospective study.
OBJECTIVE
The recent improvements of management of patients in pediatric intensive care units (PICU) are associated with improved outcome. However, this decrease in mortality is associated with an increased number of children with acute kidney injury (AKI), especially in patients with multiorgan failure.


METHODS
The report presents a retrospective analysis of 25 cases of AKI (assessed based on the pRIFLE criteria) in PICU within 7 years.


RESULTS
AKI was diagnosed in 1.24% of all hospitalized children. AKI percentage duration (as compared to the total hospitalization time) in the children who died vs. the survivors was 79.55% vs. 46.19%, respectively (p<0.05). The mortality rate of AKI patients was 40% which was 4.4-times higher as compared to the total mortality rate in PICU. The final cumulative survival ratio (FCSR) of patients meeting the oliguria criterion (which was met in 48% of AKI patients) was 37% vs. 49% in non-oliguric children. Averaged urine output values in the first week of hospitalization in the deceased vs. survivors were 1.49 vs. 2.57 ml/kg/h, respectively (p<0.05).


CONCLUSIONS
Oliguria should not be considered as a sensitive parameter for AKI diagnosing in children below one year of age. A decreased mean urine output in the first week of PICU hospitalization (less than 1.4 ml/kg/h) should be considered as a poor prognostic factor. In many cases AKI was diagnosed too infrequently and too late.
Department of Pediatric Nephrology, Jagiellonian University Medical College, Kraków, Poland.
Monika
M
Miklaszewska
Przemysław
P
Korohoda
Alina
A
Sobczak
Anna
A
Horbaczewska
Agata
A
Filipiak
Katarzyna
K
Zachwieja
Krzysztof
K
Kobylarz
Marcin
M
Tkaczyk
Dorota
D
Drożdż
Jacek A
JA
Pietrzyk
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D019468:Disease Management; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D009846:Oliguria / Q000503:physiopathology; D011044:Poland; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D003404:Creatinine