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Published in: Pediatric Nephrology 8/2016

01-08-2016 | Original Article

Prevalence of acute kidney injury during pediatric admissions for acute chest syndrome

Authors: Jeffrey D. Lebensburger, Prasannalaxmi Palabindela, Thomas H. Howard, Daniel I. Feig, Inmaculada Aban, David J. Askenazi

Published in: Pediatric Nephrology | Issue 8/2016

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Abstract

Background

Patients with sickle cell disease are at risk for developing chronic kidney disease (CKD). Acute kidney injury (AKI) has been linked to progression to CKD, but limited data exist to determine its role in acute complications of sickle cell disease. We hypothesized that AKI occurs in pediatric patients admitted for acute chest syndrome (ACS) and prolongs hospitalization.

Methods

We conducted a 6-year retrospective review of pediatric patients with ACS admitted to a single medical institution.

Results

Of the 149 pediatric patients admitted for ACS during the 6-year study period, 12 (8 %) developed AKI. Comparison of patients with and without AKI revealed a significant association between AKI and a larger drop in hemoglobin value from baseline (2.7 vs. 1.4 g/dL; p = 0.003), a lower hemoglobin value at admission (6.4 vs. 7.5 g/dL; p = 0.03), and an increased white blood cell count at admission (33.1 vs. 19.8 × 109/L; p < 0.0001), respectively. AKI (p < 0.0001) together with need for advanced respiratory support (biphasic positive airway pressure or mechanical ventilation) (p < 0.0001) and need for exchange transfusion (p < 0.0001) were associated with prolonged hospitalization.

Conclusions

Clinicians should monitor pediatric patients hospitalized for ACS for the development of AKI as a potentially modifiable risk factor for prolonged hospitalization.
Literature
1.
go back to reference Hamideh D, Alvarez O (2013) Sickle cell disease related mortality in the United States (1999–2009). Pediatr Blood Cancer 60:1482–1486CrossRefPubMed Hamideh D, Alvarez O (2013) Sickle cell disease related mortality in the United States (1999–2009). Pediatr Blood Cancer 60:1482–1486CrossRefPubMed
2.
go back to reference Powars DR, Chan LS, Hiti A, Ramicone E, Johnson C (2005) Outcome of sickle cell anemia: a 4-decade observational study of 1056 patients. Medicine (Baltimore) 84:363–376CrossRef Powars DR, Chan LS, Hiti A, Ramicone E, Johnson C (2005) Outcome of sickle cell anemia: a 4-decade observational study of 1056 patients. Medicine (Baltimore) 84:363–376CrossRef
3.
go back to reference Gosmanova EO, Zaidi S, Wan JY, Adams-Graves PE (2014) Prevalence and progression of chronic kidney disease in adult patients with sickle cell disease. J Investig Med 62:804–807CrossRefPubMed Gosmanova EO, Zaidi S, Wan JY, Adams-Graves PE (2014) Prevalence and progression of chronic kidney disease in adult patients with sickle cell disease. J Investig Med 62:804–807CrossRefPubMed
4.
go back to reference McClellan AC, Luthi JC, Lynch JR, Soucie JM, Kulkarni R, Guasch A, Huff ED, Gilbertson D, McClellan WM, DeBaun MR (2012) High one year mortality in adults with sickle cell disease and end-stage renal disease. Br J Haematol 159:360–367CrossRefPubMedPubMedCentral McClellan AC, Luthi JC, Lynch JR, Soucie JM, Kulkarni R, Guasch A, Huff ED, Gilbertson D, McClellan WM, DeBaun MR (2012) High one year mortality in adults with sickle cell disease and end-stage renal disease. Br J Haematol 159:360–367CrossRefPubMedPubMedCentral
5.
go back to reference Powars DR, Elliott-Mills DD, Chan L, Niland J, Hiti AL, Opas LM, Johnson C (1991) Chronic renal failure in sickle cell disease: risk factors, clinical course, and mortality. Ann Intern Med 115:614–620CrossRefPubMed Powars DR, Elliott-Mills DD, Chan L, Niland J, Hiti AL, Opas LM, Johnson C (1991) Chronic renal failure in sickle cell disease: risk factors, clinical course, and mortality. Ann Intern Med 115:614–620CrossRefPubMed
6.
go back to reference Lebensburger J, Johnson SM, Askenazi DJ, Rozario NL, Howard TH, Hilliard LM (2011) Protective role of hemoglobin and fetal hemoglobin in early kidney disease for children with sickle cell anemia. Am J Hematol 86:430–432CrossRefPubMed Lebensburger J, Johnson SM, Askenazi DJ, Rozario NL, Howard TH, Hilliard LM (2011) Protective role of hemoglobin and fetal hemoglobin in early kidney disease for children with sickle cell anemia. Am J Hematol 86:430–432CrossRefPubMed
7.
go back to reference Miller ST, Wang WC, Iyer R, Rana S, Lane P, Ware RE, Li D, Rees RC, Investigators B-H (2010) Urine concentrating ability in infants with sickle cell disease: baseline data from the phase III trial of hydroxyurea (BABY HUG). Pediatr Blood Cancer 54:265–268PubMedPubMedCentral Miller ST, Wang WC, Iyer R, Rana S, Lane P, Ware RE, Li D, Rees RC, Investigators B-H (2010) Urine concentrating ability in infants with sickle cell disease: baseline data from the phase III trial of hydroxyurea (BABY HUG). Pediatr Blood Cancer 54:265–268PubMedPubMedCentral
8.
go back to reference Wang WC, Ware RE, Miller ST, Iyer RV, Casella JF, Minniti CP, Rana S, Thornburg CD, Rogers ZR, Kalpatthi RV, Barredo JC, Brown RC, Sarnaik SA, Howard TH, Wynn LW, Kutlar A, Armstrong FD, Files BA, Goldsmith JC, Waclawiw MA, Huang X, Thompson BW, Investigators BH (2011) Hydroxycarbamide in very young children with sickle-cell anaemia: a multicentre, randomised, controlled trial (BABY HUG). Lancet 377:1663–1672CrossRefPubMedPubMedCentral Wang WC, Ware RE, Miller ST, Iyer RV, Casella JF, Minniti CP, Rana S, Thornburg CD, Rogers ZR, Kalpatthi RV, Barredo JC, Brown RC, Sarnaik SA, Howard TH, Wynn LW, Kutlar A, Armstrong FD, Files BA, Goldsmith JC, Waclawiw MA, Huang X, Thompson BW, Investigators BH (2011) Hydroxycarbamide in very young children with sickle-cell anaemia: a multicentre, randomised, controlled trial (BABY HUG). Lancet 377:1663–1672CrossRefPubMedPubMedCentral
9.
go back to reference Statius van Eps LW, Pinedo-Veels C, de Vries GH, de Koning J (1970) Nature of concentrating defect in sickle-cell nephropathy. Microradioangiographic studies. Lancet 1:450–452CrossRefPubMed Statius van Eps LW, Pinedo-Veels C, de Vries GH, de Koning J (1970) Nature of concentrating defect in sickle-cell nephropathy. Microradioangiographic studies. Lancet 1:450–452CrossRefPubMed
10.
go back to reference Aygun B, Mortier NA, Smeltzer MP, Hankins JS, Ware RE (2011) Glomerular hyperfiltration and albuminuria in children with sickle cell anemia. Pediatr Nephrol 26:1285–1290CrossRefPubMedPubMedCentral Aygun B, Mortier NA, Smeltzer MP, Hankins JS, Ware RE (2011) Glomerular hyperfiltration and albuminuria in children with sickle cell anemia. Pediatr Nephrol 26:1285–1290CrossRefPubMedPubMedCentral
11.
go back to reference Chawla LS, Eggers PW, Star RA, Kimmel PL (2014) Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med 371:58–66CrossRefPubMed Chawla LS, Eggers PW, Star RA, Kimmel PL (2014) Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med 371:58–66CrossRefPubMed
12.
go back to reference Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C, Beginning, Ending Supportive Therapy for the Kidney I (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818CrossRefPubMed Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C, Beginning, Ending Supportive Therapy for the Kidney I (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818CrossRefPubMed
13.
go back to reference Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW (2005) Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 16:3365–3370CrossRefPubMed Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW (2005) Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 16:3365–3370CrossRefPubMed
14.
go back to reference Chawla LS, Amdur RL, Amodeo S, Kimmel PL, Palant CE (2011) The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int 79:1361–1369CrossRefPubMedPubMedCentral Chawla LS, Amdur RL, Amodeo S, Kimmel PL, Palant CE (2011) The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int 79:1361–1369CrossRefPubMedPubMedCentral
15.
go back to reference Schneider J, Khemani R, Grushkin C, Bart R (2010) Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med 38:933–939CrossRefPubMed Schneider J, Khemani R, Grushkin C, Bart R (2010) Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med 38:933–939CrossRefPubMed
16.
go back to reference Audard V, Homs S, Habibi A, Galacteros F, Bartolucci P, Godeau B, Renaud B, Levy Y, Grimbert P, Lang P, Brun-Buisson C, Brochard L, Schortgen F, Maitre B, Mekontso Dessap A (2010) Acute kidney injury in sickle patients with painful crisis or acute chest syndrome and its relation to pulmonary hypertension. Nephrol Dial Transplant 25:2524–2529CrossRefPubMed Audard V, Homs S, Habibi A, Galacteros F, Bartolucci P, Godeau B, Renaud B, Levy Y, Grimbert P, Lang P, Brun-Buisson C, Brochard L, Schortgen F, Maitre B, Mekontso Dessap A (2010) Acute kidney injury in sickle patients with painful crisis or acute chest syndrome and its relation to pulmonary hypertension. Nephrol Dial Transplant 25:2524–2529CrossRefPubMed
17.
go back to reference Kidney Diseases: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group (2012). KDIGO clinical practice guidelines for acute kidney Injury. Kidney Int Suppl 2:1–138 Kidney Diseases: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group (2012). KDIGO clinical practice guidelines for acute kidney Injury. Kidney Int Suppl 2:1–138
18.
go back to reference Miller ST (2011) How I treat acute chest syndrome in children with sickle cell disease. Blood 117:5297–5305CrossRefPubMed Miller ST (2011) How I treat acute chest syndrome in children with sickle cell disease. Blood 117:5297–5305CrossRefPubMed
19.
go back to reference De Montalembert M, Abboud MR, Fiquet A, Inati A, Lebensburger JD, Kaddah N, Mokhtar G, Piga A, Halasa N, Inusa B, Rees DC, Heath PT, Telfer P, Driscoll C, Al Hajjar S, Tozzi A, Jiang Q, Emini EA, Gruber WC, Gurtman A, Scott DA (2015) 13-valent pneumococcal conjugate vaccine (PCV13) is immunogenic and safe in children 6–17 years of age with sickle cell disease previously vaccinated with 23-valent pneumococcal polysaccharide vaccine (PPSV23): results of a phase 3 study. Pediatr Blood Cancer 62:1427–1436CrossRefPubMed De Montalembert M, Abboud MR, Fiquet A, Inati A, Lebensburger JD, Kaddah N, Mokhtar G, Piga A, Halasa N, Inusa B, Rees DC, Heath PT, Telfer P, Driscoll C, Al Hajjar S, Tozzi A, Jiang Q, Emini EA, Gruber WC, Gurtman A, Scott DA (2015) 13-valent pneumococcal conjugate vaccine (PCV13) is immunogenic and safe in children 6–17 years of age with sickle cell disease previously vaccinated with 23-valent pneumococcal polysaccharide vaccine (PPSV23): results of a phase 3 study. Pediatr Blood Cancer 62:1427–1436CrossRefPubMed
20.
go back to reference Meier ER, Wright EC, Miller JL (2014) Reticulocytosis and anemia are associated with an increased risk of death and stroke in the newborn cohort of the Cooperative Study of Sickle Cell Disease. Am J Hematol 89:904–906CrossRefPubMedPubMedCentral Meier ER, Wright EC, Miller JL (2014) Reticulocytosis and anemia are associated with an increased risk of death and stroke in the newborn cohort of the Cooperative Study of Sickle Cell Disease. Am J Hematol 89:904–906CrossRefPubMedPubMedCentral
21.
go back to reference Lebensburger JD, Miller ST, Howard TH, Casella JF, Brown RC, Lu M, Iyer RV, Sarnaik S, Rogers ZR, Wang WC, Investigators BH (2012) Influence of severity of anemia on clinical findings in infants with sickle cell anemia: analyses from the BABY HUG study. Pediatr Blood Cancer 59:675–678CrossRefPubMed Lebensburger JD, Miller ST, Howard TH, Casella JF, Brown RC, Lu M, Iyer RV, Sarnaik S, Rogers ZR, Wang WC, Investigators BH (2012) Influence of severity of anemia on clinical findings in infants with sickle cell anemia: analyses from the BABY HUG study. Pediatr Blood Cancer 59:675–678CrossRefPubMed
22.
go back to reference Dowling MM, Quinn CT, Plumb P, Rogers ZR, Rollins NK, Koral K, Buchanan GR (2012) Acute silent cerebral ischemia and infarction during acute anemia in children with and without sickle cell disease. Blood 120:3891–3897CrossRefPubMedPubMedCentral Dowling MM, Quinn CT, Plumb P, Rogers ZR, Rollins NK, Koral K, Buchanan GR (2012) Acute silent cerebral ischemia and infarction during acute anemia in children with and without sickle cell disease. Blood 120:3891–3897CrossRefPubMedPubMedCentral
23.
go back to reference Dowling MM, Quinn CT, Rogers ZR, Buchanan GR (2010) Acute silent cerebral infarction in children with sickle cell anemia. Pediatr Blood Cancer 54:461–464CrossRefPubMedPubMedCentral Dowling MM, Quinn CT, Rogers ZR, Buchanan GR (2010) Acute silent cerebral infarction in children with sickle cell anemia. Pediatr Blood Cancer 54:461–464CrossRefPubMedPubMedCentral
24.
go back to reference Cecchini J, Lionnet F, Djibre M, Parrot A, Stojanovic KS, Girot R, Fartoukh M (2014) Outcomes of adult patients with sickle cell disease admitted to the ICU: a case series*. Crit Care Med 42:1629–1639CrossRefPubMed Cecchini J, Lionnet F, Djibre M, Parrot A, Stojanovic KS, Girot R, Fartoukh M (2014) Outcomes of adult patients with sickle cell disease admitted to the ICU: a case series*. Crit Care Med 42:1629–1639CrossRefPubMed
25.
go back to reference Bernaudin F, Verlhac S, Arnaud C, Kamdem A, Vasile M, Kasbi F, Hau I, Madhi F, Fourmaux C, Biscardi S, Epaud R, Pondarre C (2015) Chronic and acute anemia and extracranial internal carotid stenosis are risk factors for silent cerebral infarcts in sickle cell anemia. Blood 125:1653–1661CrossRefPubMed Bernaudin F, Verlhac S, Arnaud C, Kamdem A, Vasile M, Kasbi F, Hau I, Madhi F, Fourmaux C, Biscardi S, Epaud R, Pondarre C (2015) Chronic and acute anemia and extracranial internal carotid stenosis are risk factors for silent cerebral infarcts in sickle cell anemia. Blood 125:1653–1661CrossRefPubMed
26.
go back to reference Wierenga KJ, Serjeant BE, Serjeant GR (2001) Cerebrovascular complications and parvovirus infection in homozygous sickle cell disease. J Pediatr 139:438–442CrossRefPubMed Wierenga KJ, Serjeant BE, Serjeant GR (2001) Cerebrovascular complications and parvovirus infection in homozygous sickle cell disease. J Pediatr 139:438–442CrossRefPubMed
27.
go back to reference Tracz MJ, Alam J, Nath KA (2007) Physiology and pathophysiology of heme: implications for kidney disease. J Am Soc Nephrol 18:414–420CrossRefPubMed Tracz MJ, Alam J, Nath KA (2007) Physiology and pathophysiology of heme: implications for kidney disease. J Am Soc Nephrol 18:414–420CrossRefPubMed
28.
go back to reference Nath KA, Grande JP, Haggard JJ, Croatt AJ, Katusic ZS, Solovey A, Hebbel RP (2001) Oxidative stress and induction of heme oxygenase-1 in the kidney in sickle cell disease. Am J Pathol 158:893–903CrossRefPubMedPubMedCentral Nath KA, Grande JP, Haggard JJ, Croatt AJ, Katusic ZS, Solovey A, Hebbel RP (2001) Oxidative stress and induction of heme oxygenase-1 in the kidney in sickle cell disease. Am J Pathol 158:893–903CrossRefPubMedPubMedCentral
29.
go back to reference Aygun B, Mortier NA, Smeltzer MP, Shulkin BL, Hankins JS, Ware RE (2013) Hydroxyurea treatment decreases glomerular hyperfiltration in children with sickle cell anemia. Am J Hematol 88:116–119CrossRefPubMed Aygun B, Mortier NA, Smeltzer MP, Shulkin BL, Hankins JS, Ware RE (2013) Hydroxyurea treatment decreases glomerular hyperfiltration in children with sickle cell anemia. Am J Hematol 88:116–119CrossRefPubMed
30.
go back to reference dos Santos TE, Goncalves RP, Barbosa MC, da Silva GB, Daher EF Jr (2015) Monocyte chemoatractant protein-1: a potential biomarker of renal lesion and its relation with oxidative status in sickle cell disease. Blood Cells Mol Dis 54:297–301CrossRefPubMed dos Santos TE, Goncalves RP, Barbosa MC, da Silva GB, Daher EF Jr (2015) Monocyte chemoatractant protein-1: a potential biomarker of renal lesion and its relation with oxidative status in sickle cell disease. Blood Cells Mol Dis 54:297–301CrossRefPubMed
31.
go back to reference Kilburn KH, Dowell AR (1971) Renal function in respiratory failure. Effects of hypoxia, hyperoxia, and hypercapnia. Arch Intern Med 127:754–762CrossRefPubMed Kilburn KH, Dowell AR (1971) Renal function in respiratory failure. Effects of hypoxia, hyperoxia, and hypercapnia. Arch Intern Med 127:754–762CrossRefPubMed
32.
go back to reference Basu RK, Wheeler DS (2013) Kidney-lung cross-talk and acute kidney injury. Pediatr Nephrol 28:2239–2248CrossRefPubMed Basu RK, Wheeler DS (2013) Kidney-lung cross-talk and acute kidney injury. Pediatr Nephrol 28:2239–2248CrossRefPubMed
Metadata
Title
Prevalence of acute kidney injury during pediatric admissions for acute chest syndrome
Authors
Jeffrey D. Lebensburger
Prasannalaxmi Palabindela
Thomas H. Howard
Daniel I. Feig
Inmaculada Aban
David J. Askenazi
Publication date
01-08-2016
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 8/2016
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-016-3370-0

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