Early identification of acute kidney injury in children with primary nephrotic syndrome

GAO Jie; CHEN Chao-Ying; TU Juan; GENG Hai-Yun; LI Hua-Rong; SUN Jin-Shan; WANG Nan-Nan; HUANG Yong-Li

doi:10.7499/j.issn.1008-8830.2405033

PDF(560 KB)

Chinese Journal of Contemporary Pediatrics ›› 2024, Vol. 26 ›› Issue (9) : 921-925. DOI: 10.7499/j.issn.1008-8830.2405033

CLINICAL RESEARCH

Early identification of acute kidney injury in children with primary nephrotic syndrome

GAO Jie, CHEN Chao-Ying, TU Juan, GENG Hai-Yun, LI Hua-Rong, SUN Jin-Shan, WANG Nan-Nan, HUANG Yong-Li

Author information +

History +

Abstract

Objective To investigate the incidence and risk factors for acute kidney injury (AKI) in children with primary nephrotic syndrome (PNS), as well as the role of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) in the early identification of AKI in these children. Methods A prospective collection of clinical data from children hospitalized with PNS at the Children's Hospital of the Capital Institute of Pediatrics from January 2021 to October 2022 was conducted. The children were divided into two groups based on the presence of AKI: the AKI group (47 cases) and the non-AKI group (169 cases). The risk factors for AKI in children with PNS were identified by multivariate logistic regression analysis. Urinary KIM-1 and NGAL levels were compared between the AKI and non-AKI groups, as well as among the different stages of AKI. Results The incidence of AKI in children with PNS was 21.8%. Multivariate logistic regression analysis revealed that steroid-resistant nephrotic syndrome, gastrointestinal infections, and heavy proteinuria were independent risk factors for AKI in these children with PNS (P<0.05). Urinary KIM-1 and NGAL levels were higher in the AKI group compared to the non-AKI group (P<0.05), and the urinary NGAL and KIM-1 levels in the AKI stage 2 and stage 3 subgroups were higher than those in the AKI stage 1 subgroup (P<0.017). Conclusions KIM-1 and NGAL can serve as biomarkers for the early diagnosis of AKI in children with PNS. Identifying high-risk populations for AKI in children with PNS and strengthening the monitoring of related risk factors is of significant importance.

Key words

Primary nephrotic syndrome / Acute kidney injury / Neutrophil gelatinase-associated lipocalin / Kidney injury molecule-1 / Child

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

GAO Jie, CHEN Chao-Ying, TU Juan, GENG Hai-Yun, LI Hua-Rong, SUN Jin-Shan, WANG Nan-Nan, HUANG Yong-Li. Early identification of acute kidney injury in children with primary nephrotic syndrome[J]. Chinese Journal of Contemporary Pediatrics. 2024, 26(9): 921-925 https://doi.org/10.7499/j.issn.1008-8830.2405033

References

1 Delanaye P, Cavalier E, Pottel H. Serum creatinine: not so simple![J]. Nephron, 2017, 136(4): 302-308. PMID: 28441651. DOI: 10.1159/000469669.
2 Du Y, Zappitelli M, Mian A, et al. Urinary biomarkers to detect acute kidney injury in the pediatric emergency center[J]. Pediatr Nephrol, 2011, 26(2): 267-274. PMID: 20978799. DOI: 10.1007/s00467-010-1673-0.
3 中华医学会儿科学分会肾脏学组. 儿童激素敏感、复发/依赖肾病综合征诊治循证指南（2016）[J]. 中华儿科杂志, 2017, 55(10): 729-734. PMID: 29050108. DOI: 10.3760/cma.j.issn.0578-1310.2017.10.003.
4 Khwaja A. KDIGO clinical practice guidelines for acute kidney injury[J]. Nephron Clin Pract, 2012, 120(4): c179-c184. PMID: 22890468. DOI: 10.1159/000339789.
5 Moffett BS, Goldstein SL. Acute kidney injury and increasing nephrotoxic-medication exposure in noncritically-ill children[J]. Clin J Am Soc Nephrol, 2011, 6(4): 856-863. PMID: 21212419. PMCID: PMC3069379. DOI: 10.2215/CJN.08110910.
6 Rheault MN, Zhang L, Selewski DT, et al. AKI in children hospitalized with nephrotic syndrome[J]. Clin J Am Soc Nephrol, 2015, 10(12): 2110-2118. PMID: 26450933. PMCID: PMC4670770. DOI: 10.2215/CJN.06620615.
7 Sharma M, Mahanta A, Barman AK, et al. Acute kidney injury in children with nephrotic syndrome: a single-center study[J]. Clin Kidney J, 2018, 11(5): 655-658. PMID: 30288260. PMCID: PMC6165752. DOI: 10.1093/ckj/sfy024.
8 Yaseen A, Tresa V, Lanewala AA, et al. Acute kidney injury in idiopathic nephrotic syndrome of childhood is a major risk factor for the development of chronic kidney disease[J]. Ren Fail, 2017, 39(1): 323-327. PMID: 28093933. PMCID: PMC6014292. DOI: 10.1080/0886022X.2016.1277743.
9 Prasad BS, Kumar M, Dabas A, et al. Profile of acute kidney injury in hospitalized children with idiopathic nephrotic syndrome[J]. Indian Pediatr, 2019, 56(2): 119-122. PMID: 30819990.
10 Trautmann A, Schnaidt S, Lipska-Zi?tkiewicz BS, et al. Long-term outcome of steroid-resistant nephrotic syndrome in children[J]. J Am Soc Nephrol, 2017, 28(10): 3055-3065. PMID: 28566477. PMCID: PMC5619960. DOI: 10.1681/ASN.2016101121.
11 Chawla LS, Eggers PW, Star RA, et al. Acute kidney injury and chronic kidney disease as interconnected syndromes[J]. N Engl J Med, 2014, 371(1): 58-66. PMID: 24988558. PMCID: PMC9720902. DOI: 10.1056/NEJMra1214243.
12 Beins NT, Dell KM. Long-term outcomes in children with steroid-resistant nephrotic syndrome treated with calcineurin inhibitors[J]. Front Pediatr, 2015, 3: 104. PMID: 26640779. PMCID: PMC4661226. DOI: 10.3389/fped.2015.00104.
13 James MT, Hemmelgarn BR, Wiebe N, et al. Glomerular filtration rate, proteinuria, and the incidence and consequences of acute kidney injury: a cohort study[J]. Lancet, 2010, 376(9758): 2096-2103. PMID: 21094997. DOI: 10.1016/S0140-6736(10)61271-8.
14 Lionaki S, Liapis G, Boletis JN. Pathogenesis and management of acute kidney injury in patients with nephrotic syndrome due to primary glomerulopathies[J]. Medicina (Kaunas), 2019, 55(7): 365. PMID: 31336742. PMCID: PMC6681356. DOI: 10.3390/medicina55070365.
15 高洁, 陈朝英, 涂娟, 等. 儿童原发肾病综合征并发急性肾损伤相关因素分析[J]. 中国医刊, 2020, 55(2): 217-220. DOI: 10.3969/j.issn.1008-1070.2020.02.030.
16 Nawaz S, Afzal K. Pediatric acute kidney injury in North India: a prospective hospital-based study[J]. Saudi J Kidney Dis Transpl, 2018, 29(3): 689-697. PMID: 29970747. DOI: 10.4103/1319-2442.235172.
17 Jo SK, Yang J, Hwang SM, et al. Role of biomarkers as predictors of acute kidney injury and mortality in decompensated cirrhosis[J]. Sci Rep, 2019, 9(1): 14508. PMID: 31601879. PMCID: PMC6787185. DOI: 10.1038/s41598-019-51053-8.
18 Schmidt-Ott KM, Mori K, Li JY, et al. Dual action of neutrophil gelatinase-associated lipocalin[J]. J Am Soc Nephrol, 2007, 18(2): 407-413. PMID: 17229907. DOI: 10.1681/ASN.2006080882.
19 Menez S, Parikh CR. Assessing the health of the nephron in acute kidney injury: biomarkers of kidney function and injury[J]. Curr Opin Nephrol Hypertens, 2019, 28(6): 560-566. PMID: 31369422. PMCID: PMC7391114. DOI: 10.1097/MNH.0000000000000538.
20 Vaidya VS, Ramirez V, Ichimura T, et al. Urinary kidney injury molecule-1: a sensitive quantitative biomarker for early detection of kidney tubular injury[J]. Am J Physiol Renal Physiol, 2006, 290(2): F517-F529. PMID: 16174863. DOI: 10.1152/ajprenal.00291.2005.
21 Schrezenmeier EV, Barasch J, Budde K, et al. Biomarkers in acute kidney injury: pathophysiological basis and clinical performance[J]. Acta Physiol (Oxf), 2017, 219(3): 554-572. PMID: 27474473. PMCID: PMC5575831. DOI: 10.1111/apha.12764.