Acute kidney injury following spinal instrumentation surgery in children.
OBJECTIVE
To determine acute kidney in jury (AKI) incidence and potential risk factors of AKI in children undergoing spinal instrumentation surgery.


METHODS
AKI incidence in children undergoing spinal instrumentation surgery at British Columbia Children's Hospital between January 2006 and December 2008 was determined by the Acute Kidney Injury Networ classification using serum creatinine and urine output criteria. During this specific time period, all patients following spinal surgery were monitored in the pediatric intensive care unit and had an indwelling Foley catheter permitting hourly urine output recording. Cases of AKI were identified from our database. From the remaining cohort, we selected group-matched controls that did not satisfy criteria for AKI. The controls were matched for sex, age and underlying diagnosis (idiopathicvsnon-idiopathic scoliosis).


RESULTS
Thirty five of 208 patients met criteria for AKI with an incidence of 17% (95%CI: 12%-23%). Of all children who developed AKI, 17 (49%) developed mild AKI (AKI Stage 1), 17 (49%) developed moderate AKI (Stage 2) and 1 patient (3%) met criteria for severe AKI (Stage 3). An inverse relationship was observed with AKI incidence and the amount of fluids received intra-operatively. An inverse relationship was observed with AKI incidence and the amount of fluids received intra-operatively classified by fluid tertiles: 70% incidence in those that received the least amount of fluidsvs29% that received the most fluids (> 7.9,P= 0.02). Patients who developed AKI were more frequently exposed to nephrotoxins (non steroidal anti inflammatory drugs or aminoglycosides) than control patients during their peri-operative course (60%vs22%,P< 0.001).


CONCLUSIONS
We observed a high incidence of AKI following spinal instrumentation surgery in children that is potentially related to the frequent use of nephrotoxins and the amount of fluid administered peri-operatively.
Jasper J Jöbsis, Department of Paediatrics, Tergooi Hospital, 1261 AN Blaricum, The Netherlands.
Jasper J
JJ
Jöbsis
Jasper J Jöbsis, Department of Paediatrics, Tergooi Hospital, 1261 AN Blaricum, The Netherlands.
Abdullah
A
Alabbas
Jasper J Jöbsis, Department of Paediatrics, Tergooi Hospital, 1261 AN Blaricum, The Netherlands.
Ruth
R
Milner
Jasper J Jöbsis, Department of Paediatrics, Tergooi Hospital, 1261 AN Blaricum, The Netherlands.
Christopher
C
Reilly
Jasper J Jöbsis, Department of Paediatrics, Tergooi Hospital, 1261 AN Blaricum, The Netherlands.
Kishore
K
Mulpuri
Jasper J Jöbsis, Department of Paediatrics, Tergooi Hospital, 1261 AN Blaricum, The Netherlands.
Cherry
C
Mammen
Acute Kidney Injury Network; Acute kidney injury; Children; Epidemiology; Spinal surgery