Aftab S. Chishti

Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study

Background Single-center studies suggest that neonatal acute kidney injury (AKI) is associated with poor outcomes. However, inferences regarding the association between AKI, mortality, and hospital length of stay are limited due to the small sample size of those studies. In order to determine whether neonatal AKI is independently associated with increased mortality and longer hospital stay, we analyzed the Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) database. Methods All neonates admitted to 24 participating neonatal intensive care units from four countries (Australia, Canada, India, United States) between January 1 and March 31, 2014, were screened. Of 4273 neonates screened, 2022 (47·3%) met study criteria. Exclusion criteria included: no intravenous fluids ≥48 hours, admission ≥14 days of life, congenital heart disease requiring surgical repair at <7 days of life, lethal chromosomal anomaly, death within 48 hours, inability to determine AKI status or severe congenital kidney abnormalities. AKI was defined using a standardized definition —i.e., serum creatinine rise of ≥0.3 mg/dL (26.5 mcmol/L) or ≥50% from previous lowest value, and/or if urine output was <1 mL/kg/h on postnatal days 2 to 7. Findings Incidence of AKI was 605/2022 (29·9%). Rates varied by gestational age groups (i.e., ≥22 to <29 weeks =47·9%; ≥29 to <36 weeks =18·3%; and ≥36 weeks =36·7%). Even after adjusting for multiple potential confounding factors, infants with AKI had higher mortality compared to those without AKI [(59/605 (9·7%) vs. 20/1417 (1·4%); p< 0.001; adjusted OR=4·6 (95% CI=2·5–8·3); p=<0·0001], and longer hospital stay [adjusted parameter estimate 8·8 days (95% CI=6·1–11·5); p<0·0001]. Interpretation Neonatal AKI is a common and independent risk factor for mortality and longer hospital stay. These data suggest that neonates may be impacted by AKI in a manner similar to pediatric and adult patients. Funding US National Institutes of Health, University of Alabama at Birmingham, Cincinnati Children’s, University of New Mexico.

Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates: Design of a Retrospective Cohort Study

Introduction Acute kidney injury (AKI) affects ~30% of hospitalized neonates. Critical to advancing our understanding of neonatal AKI is collaborative research among neonatologists and nephrologists. The Neonatal Kidney Collaborative (NKC) is an international, multidisciplinary group dedicated to investigating neonatal AKI. The AWAKEN study (Assessment of Worldwide Acute Kidney injury Epidemiology in Neonates) was designed to describe the epidemiology of neonatal AKI, validate the definition of neonatal AKI, identify primary risk factors for neonatal AKI, and investigate the contribution of fluid management to AKI events and short-term outcomes. Methods and analysis The NKC was established with at least one pediatric nephrologist and neonatologist from 24 institutions in 4 countries (USA, Canada, Australia, and India). A Steering Committee and four subcommittees were created. The database subcommittee oversaw the development of the web-based database (MediData Rave™) that captured all NICU admissions from 1/1/14 to 3/31/14. Inclusion and exclusion criteria were applied to eliminate neonates with a low likelihood of AKI. Data collection included: (1) baseline demographic information; (2) daily physiologic parameters and care received during the first week of life; (3) weekly “snapshots”; (4) discharge information including growth parameters, final diagnoses, discharge medications, and need for renal replacement therapy; and (5) all serum creatinine values. Ethics and dissemination AWAKEN was proposed as human subjects research. The study design allowed for a waiver of informed consent/parental permission. NKC investigators will disseminate data through peer-reviewed publications and educational conferences. Discussion The purpose of this publication is to describe the formation of the NKC, the establishment of the AWAKEN cohort and database, future directions, and a few “lessons learned.” The AWAKEN database includes ~325 unique variables and >4 million discrete data points. AWAKEN will be the largest, most inclusive neonatal AKI study to date. In addition to validating the neonatal AKI definition and identifying risk factors for AKI, this study will uncover variations in practice patterns related to fluid provision, renal function monitoring, and involvement of pediatric nephrologists during hospitalization. The AWAKEN study will position the NKC to achieve the long-term goal of improving the lives, health, and well-being of newborns at risk for kidney disease.

A guideline for the inpatient care of children with pyelonephritis.

Background and Objectives :Febrile urinary tract infections and pyelonephritis are common in children and frequently lead to hospitalization for management, especially in the child who appears toxic. The American Academy of Pediatrics (AAP) practice parameter on the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children provides experience and evidence-based guidelines for the practitioner caring for children between the ages of 2 months to 2 years. No established guideline exists for older children and the AAP guideline does not specifically focus on inpatient care. Methods : We conducted a comprehensive review of recently published literature and practice guidelines to develop a consensus on the inpatient diagnosis and management of children with pyelonephritis. Results : Eight recommendations are proposed for the diagnosis and management, including revised guidelines for the imaging studies postpyelonephritis on the basis of current best evidence. Conclusion : Proper diagnosis of pyelonephritis, timely initiation of appropriate therapy and identification of children at risk for renal injury will help to reduce immediate as well as long-term complications due to chronic kidney disease.

Kidney and urinary tract diseases in the newborn

Kidney and urinary tract diseases in the newborn / , Kidney and urinary tract diseases in the newborn / , کتابخانه دیجیتال جندی شاپور اهواز

Management of pediatric hypertension

Hypertension is one of the major contributors to cardiovascular, renal and CNS morbidity and mortality. Although it is more prevalent in adults, hypertension and its sequelae are being seen with increasing frequency in pediatrics recently. The majority of children have hypertension secondary to renovascular and renal parenchymal disease, and it appears that the increased incidence is primarily related to the epidemic of obesity, which is a known risk factor for the development of the condition. After the diagnosis of hypertension is established, a thorough evaluation for secondary causes should be conducted according to existing guidelines. Nonpharmacologic interventions should be discussed in any child, even though the diagnosis of hypertension may not be confi rmed, but if risk factors are identifi ed. Those interventions should be even more encouraged if the diagnosis of hypertension or prehypertension is confi rmed. Nonpharmacologic intervention focuses on salt restriction, diet modifi cation, exercise and physical activity, as well as improved sleep habits. Initiation of medical therapy is guided by the degree of blood pressure elevation, presence of symptoms and existing risk factors. A wide variety of oral medications and intravenous therapies are available for use in children with mild, moderate or severe blood pressure elevations. This article reviews the diagnosis and evaluation of hypertension in children, and provides an update on the pharmacologic and nonpharmacologic treatment options for hypertension, including hypertensive urgency and emergency.

Fibroblast growth factor-23 and chronic allograft injury in pediatric renal transplant recipients: a Midwest Pediatric Nephrology Consortium study.

The chronic kidney disease‐mineral bone disorder (CKD‐MBD) produces fibroblast growth factor‐23 (FGF‐23) and related circulating pathogenic factors that are strongly associated with vascular injury and declining kidney function in native CKD. Similarly, chronic renal allograft injury (CRAI) is characterized by vascular injury and declining allograft function in transplant CKD. We hypothesized that circulating CKD‐MBD factors could serve as non‐invasive biomarkers of CRAI. We conducted a cross‐sectional, multicenter case–control study. Cases (n = 31) had transplant function >20 mL/min/1.73 m2 and biopsy‐proven CRAI. Controls (n = 31) had transplant function >90 mL/min/1.73 m2 and/or a biopsy with no detectable abnormality in the previous six months. We measured plasma CKD‐MBD factors at a single time point using ELISA. Median (range) FGF23 levels were over twofold higher in CRAI vs. controls [106 (10–475) pg/mL vs. 45 (8–91) pg/mL; p < 0.001]. FGF23 levels were inversely correlated with transplant function (r2 = −0.617, p < 0.001). Higher FGF23 levels were associated with increased odds of biopsy‐proven CRAI after adjusting for transplant function, clinical, and demographic factors [OR (95% CI) 1.43 (1.23, 1.67)]. Relationships between additional CKD‐MBD factors and CRAI were attenuated in multivariable models. Higher FGF23 levels were independently associated with biopsy‐proven CRAI in children.

Assessment of Renal Function

UA is the oldest method of diagnostic urine testing, first used more than 6,000 years ago [20]. Often neglected by the clinicians and poorly performed by laboratories, it is an inexpensive, readily available, and easy to interpret test with or without automated analyzers. It is an excellent indicator of a variety of renal functions, and some people consider it as a medical “poor man’s” biopsy of the kidney.

Adults who had kidney disease in childhood

Abstract A young adult male who recently turned 21 years of age has been followed by a group of pediatric kidney specialists since birth as he was born with a single dysplastic kidney. He progressed towards end stage renal disease and started hemodialysis in a pediatric inpatient center at the age of 19 years. Owing to being significantly overweight, he is not a suitable renal transplant candidate. He lives at home with his mother, who is his primary caregiver and his brother. He dropped out of school before the age of 18 years and has currently no intention to finish high school. He has short stature as he refused daily growth hormone injections in the past. During healthcare visits he has always been passive and his mother is making decisions for him. During the last several visits, he and the mother have requested initiation of transition into adult care as he feels it is now time. Both patient and mother also start to ask questions about the adult implications of his chronic kidney disease (CKD). CKD in children is somewhat complex and the implications for adults living with advanced kidney disease since childhood are significant. Optimal care of the adult patient who has been affected by advanced kidney disease since childhood requires a solid understanding of three main domains with significant overlap: (i) the underlying type of kidney disease and the multiple effects that CKD has on the body and mind of a child, (ii) the process of care transitioning from the pediatric to the adult environment, and (iii) the physical and psychosocial effects of the disease on the adult patient.