title: AKI in Children Hospitalized with Nephrotic Syndrome.
abstract: OBJECTIVE
  Children with nephrotic syndrome can develop life-threatening complications, including infection and thrombosis. While AKI is associated with adverse outcomes in hospitalized children, little is known about the epidemiology of AKI in children with nephrotic syndrome. The main objectives of this study were to determine the incidence, epidemiology, and hospital outcomes associated with AKI in a modern cohort of children hospitalized with nephrotic syndrome.
  
  
  METHODS
  Records of children with nephrotic syndrome admitted to 17 pediatric nephrology centers across North America from 2010 to 2012 were reviewed. AKI was classified using the pediatric RIFLE definition.
  
  
  RESULTS
  AKI occurred in 58.6% of 336 children and 50.9% of 615 hospitalizations (27.3% in stage R, 17.2% in stage I, and 6.3% in stage F). After adjustment for race, sex, age at admission, and clinical diagnosis, infection (odds ratio, 2.24; 95% confidence interval, 1.37 to 3.65; P=0.001), nephrotoxic medication exposure (odds ratio, 1.35; 95% confidence interval, 1.11 to 1.64; P=0.002), days of nephrotoxic medication exposure (odds ratio, 1.10; 95% confidence interval, 1.05 to 1.15; P<0.001), and intensity of medication exposure (odds ratio, 1.34; 95% confidence interval, 1.09 to 1.65; P=0.01) remained significantly associated with AKI in children with nephrotic syndrome. Nephrotoxic medication exposure was common in this population, and each additional nephrotoxic medication received during a hospitalization was associated with 38% higher risk of AKI. AKI was associated with longer hospital stay after adjustment for race, sex, age at admission, clinical diagnosis, and infection (difference, 0.45 [log]days; 95% confidence interval, 0.36 to 0.53 [log]days; P<0.001).
  
  
  CONCLUSIONS
  AKI is common in children hospitalized with nephrotic syndrome and should be deemed the third major complication of nephrotic syndrome in children in addition to infection and venous thromboembolism. Risk factors for AKI include steroid-resistant nephrotic syndrome, infection, and nephrotoxic medication exposure. Children with AKI have longer hospital lengths of stay and increased need for intensive care unit admission.
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material. rheau002@umn.edu.
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Rheault
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authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
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authors.forename: David T
authors.initials: DT
authors.lastname: Selewski
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Kallash
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Tran
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Meredith
authors.initials: M
authors.lastname: Seamon
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Chryso
authors.initials: C
authors.lastname: Katsoufis
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authors.forename: Isa
authors.initials: I
authors.lastname: Ashoor
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Joel
authors.initials: J
authors.lastname: Hernandez
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Katarina
authors.initials: K
authors.lastname: Supe-Markovina
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Cynthia
authors.initials: C
authors.lastname: D'Alessandri-Silva
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Nilka
authors.initials: N
authors.lastname: DeJesus-Gonzalez
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Tetyana L
authors.initials: TL
authors.lastname: Vasylyeva
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Formeck
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Christopher
authors.initials: C
authors.lastname: Woll
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Rasheed
authors.initials: R
authors.lastname: Gbadegesin
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Pavel
authors.initials: P
authors.lastname: Geier
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Prasad
authors.initials: P
authors.lastname: Devarajan
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Carpenter
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Kerlin
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: William E
authors.initials: WE
authors.lastname: Smoyer
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008499:Medical Records; D015999:Multivariate Analysis; D009404:Nephrotic Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D009656:North America / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: acute kidney injury; child; dialysis; hospitalization; humans; incidence; length of stay; nephrotic syndrome; nephrotoxicity; risk factors