Kidney Research and Clinical Practice

Korean Society of Nephrology (대한신장학회)
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Acute kidney injury in childhood-onset nephrotic syndrome: Incidence and risk factors in hospitalized patients

  • Kim, Mi Young (Department of Pediatrics, Seoul National University Hospital) ;
  • Cho, Myung Hyun (Department of Pediatrics, Seoul National University Hospital) ;
  • Kim, Ji Hyun (Department of Pediatrics, Seoul National University Hospital) ;
  • Ahn, Yo Han (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Choi, Hyun Jin (Department of Pediatrics, Seoul National University Hospital) ;
  • Ha, Il Soo (Department of Pediatrics, Seoul National University Hospital) ;
  • Cheong, Hae Il (Department of Pediatrics, Seoul National University Hospital) ;
  • Kang, Hee Gyung (Department of Pediatrics, Seoul National University Hospital)
  • Received : 2018.08.16
  • Accepted : 2018.10.11
  • Published : 2018.12.31
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Abstract

Background: Nephrotic syndrome (NS) is the most common glomerulopathy in children. Acute kidney injury (AKI) is a common complication of NS, caused by severe intravascular volume depletion, acute tubular necrosis, interstitial nephritis, or progression of NS. However, the incidence and risk factors of childhood-onset NS in Korea are unclear. Therefore, we studied the incidence, causes, and risk factors of AKI in hospitalized Korean patients with childhood-onset NS. Methods: We conducted a retrospective review of patients with childhood-onset NS who were admitted to our center from January 2015 to July 2017. Patients with decreased renal function or hereditary/secondary NS, as well as those admitted for management of other conditions unrelated to NS, were excluded. Results: During the study period, 65 patients with idiopathic, childhood-onset NS were hospitalized 90 times for management of NS or its complications. Of these 90 cases, 29 met the Kidney Disease Improving Global Outcomes criteria for AKI (32.2%). They developed AKI in association with infection (n = 12), NS aggravation (n = 11), dehydration (n = 3), and intravenous methylprednisolone administration (n = 3). Age ${\geq}9$ years at admission and combined use of cyclosporine and renin-angiotensin system inhibitors were risk factors for AKI. Conclusion: AKI occurred in one-third of the total hospitalizations related to childhood-onset NS, owing to infection, aggravation of NS, dehydration, and possibly high-dose methylprednisolone treatment. Age at admission and use of nephrotoxic agents were associated with AKI. As the AKI incidence is high, AKI should be considered during management of high-risk patients.

Keywords

Acknowledgement

Supported by : Seoul National University Hospital

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