title: Acute kidney injury during a pediatric sickle cell vaso-occlusive pain crisis.
abstract: BACKGROUND
  Patients who develop sickle cell disease (SCD) nephropathy are at a high risk for mortality. The pathophysiology of vaso-occlusive pain crisis may contribute to acute kidney injury (AKI). Non-steroidal anti-inflammatory drugs, known inducers of AKI, are used to treat pain crises. Multiple gaps exist in the knowledge about the impact of AKI in SCD.
  
  
  METHODS
  We conducted a 2-year retrospective review of AKI events in patients admitted for vaso-occlusive crisis. AKI was defined by an increase of ≥0.3 mg/dL or 50% in serum creatinine from baseline. Laboratory values and ketorolac administration by days and dose (mg/kg) were identified from hospital records. A generalized mixed effects model for binary outcomes evaluated AKI based on laboratory variables and ketorolac administration. A generalized mixed Poisson effects model analyzed the association of AKI with hospital length of stay.
  
  
  RESULTS
  Thirty-three out of 197 admissions for vaso-occlusive pain crisis (17%) were associated with AKI. Fifty-two percent of the cases presented to the Emergency Room (ER) with AKI. Every one unit decrease in hemoglobin from baseline to admission increased the risk of AKI by 49%. Among patients who received ketorolac for pain, both total days and doses of ketorolac were associated with AKI. Finally, patients with pain and AKI required longer periods of hospitalization than patients without AKI.
  
  
  CONCLUSIONS
  Acute kidney injury during sickle cell pain crisis is common and may be an important modifiable risk factor for developing chronic kidney disease (CKD). Further studies are needed to determine the impact of nephrotoxic medications on progressive SCD nephropathy.
authors.affiliation: Pediatric Hematology and Oncology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 512, Birmingham, AL, 35233, USA.
authors.forename: Sujatha
authors.initials: S
authors.lastname: Baddam
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 512, Birmingham, AL, 35233, USA.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Aban
authors.affiliation: Pediatric Hematology and Oncology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 512, Birmingham, AL, 35233, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Hilliard
authors.affiliation: Pediatric Hematology and Oncology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 512, Birmingham, AL, 35233, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Howard
authors.affiliation: Pediatric Nephrology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 512, Birmingham, AL, 35233, USA.
authors.forename: David
authors.initials: D
authors.lastname: Askenazi
authors.affiliation: Pediatric Hematology and Oncology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 512, Birmingham, AL, 35233, USA. jlebensburger@peds.uab.edu.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Lebensburger
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D059787:Acute Pain / Q000188:drug therapy* / Q000209:etiology; D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000097:blood / Q000150:complications*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000150:complications*; D002648:Child; D003404:Creatinine / Q000097:blood; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000009:adverse effects; D007677:Kidney Function Tests; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D059408:Pain Management / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D003404:Creatinine; D020910:Ketorolac
keywords: Acute kidney injury; Nephropathy; Non-steroidal anti-inflammatory drugs; Pain; Sickle cell disease