UPmémoires

English

Background: Acute kidney injury (AKI) in children is associated with in-hospital short-term prognosis and lead to the development of chronic kidney disease (CKD) in the longer term. The incidence and characteristics of pediatric AKI remains unclear in the Emergency Department (ED) because epidemiological studies are lacking in children.

Methods: The epidemiology of AKI at the Pediatric ED of the 3 University Hospitals (Bordeaux, Limoges and Poitiers) in the Nouvelle Aquitaine region, between 2013 and 2017, was investigated. AKI was defined by an increase serum creatinine of more than 50% and then classified according to the criteria of the KDIGO guidelines with three stages of severity.

Results: A total of 172 cases of AKI were identified, corresponding to approximately 1 case per 2000 admissions to the Pediatric ED. The median age at AKI was 3.5 years. There was a slight predominance of boys (56%). The main reasons for consultation to the Pediatric ED were vomiting (66%), followed by diarrhea (53%) and fever (51%). According to the KDIGO classification, 50% of patients had AKI stage 3 (severe), 26% had AKI stage 2, and 24% had AKI stage 1 (mild). Arterial hypertension was found in 22% of patients (53% stage 1, 45% stage 2 and 2% isolated systolic hypertension). The presence of oligo-anuria (observed in 17%) was statistically associated with AKI stage 3 (p<0.01). The majority of children (72%) had prerenal causes of AKI. The primary etiology of AKI was dehydration as a result of acute gastroenteritis or related symptoms (44%), followed by sepsis-induced AKI (9%), hemolytic uremic syndrome (8%) and pyelonephritis (6%). Almost a quarter of the children with AKI admitted to the Pediatric Emergency Department were transferred to the Intensive Care Unit, 12 children (7%) required renal replacement therapy and four (2%) died during hospitalization. A least 13 children (8%) further developed CKD after admission to the emergency for AKI.

Conclusion: AKI in the Pediatric ED most often involves infants, the most common cause is dehydration, and is associated with significant morbidity. Recognition of AKI in the Pediatric ED may be essential to improve patient care and identify patients at risk for early complications and CKD in the long-term.