Department of Paediatrics

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Browsing Department of Paediatrics by Subject "Acute kidney injury"

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    Open Access
    Cardiac surgery-associated acute kidney injury in a developing country: Prevalence, risk factors and outcome
    (Wolters Kluwer Medknow Publications, 2015-05) Ekure, E.N.; Esezobor, C.I.; Sridhar, A.; Vasudevan, J.; Subramanyan, R.; Cherian, K.M.
    Little is known about cardiac surgery-associated acute kidney injury (CS-AKI) in children in developing regions of the world. The study aimed to determine the prevalence of CS- AKI, associated factors and its impact on mortality and utilization of hospital services. The hospital records of children aged 0–17 years who underwent CS at an Indian hospital were reviewed. CS-AKI was defined as a rise in serum creatinine of ≥0.3 mg/dL in any 48 h and or by urine output <0.5 mL/kg/h for an 8-h period in the first five days after CS. The study included 323 children with a median age of one year (0.04–17), of whom 22 (6.8%) were neonates and 18.3% had a single ventricle. About 60% of the children had Risk Adjusted Congenital Heart Surgery–I category 1 or 2 interventions. CS-AKI occurred in 39 children (12.1%). Factors associated with CS-AKI were sepsis and intra- and post-operative hypotension. In-hospital mortality was six-fold higher in children who developed CS-AKI. CS-AKI was associated with two to three days more of mechanical ventilation and Intensive care unit stay. CS-AKI occurs in children in developing countries, but at a lower frequency mainly due to the predominance of post-neonatal children undergoing less-complex CSs. CS-AKI was associated with higher in-hospital mortality and increased utilization of hospital services. Factors associated with CS-AKI included intra- and post-operative hypotension and sepsis.
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    Open Access
    Diagnosing renal failure due to diethylene glycol in children in a resource-constrained setting
    (Springer, 2012-06) Akuse, R.M.; Eke, F.U.; Ademola, A.D.; Fajolu, I.B.; Gbelee, H.O.; Ihejiahi, U.; Bugaje, M.J.; Anochie, I.C.; Asinobi, A.O.; Okafor, H.U.; Adeleke, S.I.; Audu, L.I.; Otuneye, A.; Disu, E.; Idris, H.; Aikhonbare, H.; Yakubu, A.; Ogala, W.; Ogunrinde, O.; Wammanda, R.; Orogade, A.; Anyiam, J.; Eseigbe, E.; Umar, L.; Musa, H.; Onalo, R.; West, B.; Paul, N.; Lesi, F.; Ladapo, T.A.; Boyede, O.; Okeowo, R.; Mustapha, A.; Akinola, I.; Chima-Oduko, O.; Awobusuyi, O.
    Background In 2008, several Nigerian children developed acute kidney injury (AKI) after ingesting teething syrup contaminated with diethylene glycol (DEG). Because there are limited diagnostic facilities in resource-constrained countries, this study investigated whether AKI associated with DEG could be identified by other means. Methods This was a multicenter study. Information was obtained from hospital records. Clinicopathological features of all children with AKI over a 6-month period were reviewed. Results Sixty (50.4%) of 119 children ingested “My pikin” teething syrup. Compared to children who had not ingested it, they were significantly (p < 0.05) younger (11.95 vs. 31 months), more were anuric (98.3 vs. 74.6%), hypertensive (84 vs. 52%), had severe metabolic acidosis (46.7 vs. 20.5%), and died (96.6 vs. 71.2%). They developed increasing metabolic acidosis and multiorgan dysfunction despite peritoneal dialysis. Late presentation, financial difficulties, inadequate facilities for toxicology, and hemodialysis complicated management. Conclusions Identifying AKI associated with DEG is difficult. Detailed drug history, increasing metabolic acidosis, and multiorgan deterioration despite peritoneal dialysis should arouse suspicion. Simple diagnostic tests need to be developed and facilities for hemodialysis of infants and financial support provided. Recurrences can be prevented by creating awareness, improving manufacturing practices, field-testing of drugs, and international monitoring of pharmaceuticals imported for manufacture.