title: Acute kidney injury associated with high nephrotoxic medication exposure leads to chronic kidney disease after 6 months.
abstract: OBJECTIVE
  To assess the development of chronic kidney disease (CKD) after high nephrotoxic medication exposure-associated acute kidney injury (NTMx-AKI) in hospitalized children.
  
  
  METHODS
  We performed a retrospective cohort study of children exposed to an aminoglycoside for ≥3 days or ≥3 nephrotoxic medications simultaneously for the development of CKD at 6 months. Follow-up data >6 months after acute kidney injury (AKI) were retrieved from electronic health records. Outcomes in children with NTMx-AKI were compared with patients of same age and primary service distribution who were exposed to nephrotoxic medications but did not develop AKI (controls).
  
  
  RESULTS
  One hundred patients with NTMx-AKI were assessed (mean age of 9.3 ± 6.9 years). Commonly involved services were bone marrow transplantation/oncology (59%), liver transplantation (13%), and pulmonary (13%). Pre-AKI estimated glomerular filtration rate (eGFR) was 119 ± 14.5 mL/min/1.73 m(2) (range 90-150 mL/min/1.73 m(2)). Mean discharge eGFR was 105.1 ± 27.1 mL/min/1.73 m(2). At 6 months after NTMx-AKI, eGFR (n = 77) was 113.8 ± 30.6 mL/min/1.73 m(2). Sixteen (20.7%) had eGFR of 60-90, 2 (2.6%) had eGFR <60, and 9 (11.6%) had eGFR >150 mL/min/1.73 m(2) (hyperfiltration). Twenty-four (68.5%) of 35 patients who were assessed for proteinuria had a urine protein-to-creatinine ratio >0.3 mg/mg, and 29 (37.6%) had hypertension. Twenty-six (33.7%) patients had CKD (proteinuria or eGFR <60 mL/min/1.73 m(2)). An additional 28 (36.3%) were considered to be at risk for CKD with hypertension, eGFR between 60 and 90 mL/min/1.73 m(2), or eGFR >150 mL/min/1.73 m(2). CKD, hypertension, and proteinuria were more common in the AKI cohort than in controls.
  
  
  CONCLUSIONS
  Six months after NTMx-AKI, 70% of patients had evidence of residual kidney damage (reduced eGFR, hyperfiltration, proteinuria, or hypertension). Few underwent a complete evaluation for CKD. With studies showing an association between AKI and CKD, we suggest systematic comprehensive follow-up in children after NTMx-AKI.
authors.affiliation: Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: smenon@med.wayne.edu.
authors.forename: Shina
authors.initials: S
authors.lastname: Menon
authors.affiliation: Division of Hospital Medicine, Division of Biomedical Informatics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Kirkendall
authors.affiliation: Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Hovi
authors.initials: H
authors.lastname: Nguyen
authors.affiliation: Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications*; D000617:Aminoglycosides / Q000009:adverse effects*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000187:drug effects*; D007674:Kidney Diseases / Q000139:chemically induced; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000617:Aminoglycosides