- Acute kidney injury in neonates after plasty of the aortic arch
Acute kidney injury in neonates after plasty of the aortic arch
Modern pediatrics. Ukraine. 2019.4(100):8-11; doi 10.15574/SP.2019.100.8
Chernyshuk S. S., Adamovska O. A., Zhovnir V. A.
Ukrainian Children's Cardiac Center, Kyiv, Ukrainе
For citation: Chernyshuk SS, Adamovska OA, Zhovnir VA. (2019). Acute kidney injury in neonates after plasty of the aortic arch. Modern pediatrics. Ukraine. 4(100): 8-11. doi 10.15574/SP.2019.100.8
Article received: Jan 11, 2019. Accepted for publication: May 08, 2019.
The purpose of study was to hold the single-center study of the incidence of acute kidney injury (AKI) in newborns that underwent surgical correction of the aortic arch pathology and make the prospective analysis of the effect of AKI on postoperative course and mortality in this category of patients.
Material and methods. From 07.01.2015 to 12.15.2015, 120 newborns with congenital heart diseases had undergone cardiac surgery in the Ukrainian Children Cardiac Center. Among them, 25 patients had pathology of the aortic arch. Of these, 8 (32%) newborns had isolated coarctation of the aorta, and 17 (68%) patients had a combination of coarctation of the aorta with other congenital heart defects. Based on the change in serum creatinine level, we studied the incidence of AKI, risk factors and complications that possibly may emerge due to its occurrence.
Results and discussion. According to our data, the AKI has emerged in 53% (n=63) of newborns that underwent the cardiac surgery. Meanwhile patients with pathology of the aortic arch showed up with the acute kidney injury in 80% (n=20) cases. The incidence of AKI in newborns, in whom the aortic arch was corrected without the use of cardiopulmonary bypass, was 72% (n=13). At the same time among the patients that underwent the cardiac surgery with cardiopulmonaru bypass, AKI appeared in 100% (n=7) of cases. We noted that newborns with AKI more often required inotropic support and mechanical ventilation during the preoperative stage. Also, the level of serum creatinine concentration was higher, and they often developed acute renal failure before surgery. In the postoperative period, among patients with acute renal failure, 9 (45%) had injury AKIN 1, 2 (10%) had AKIN 2 and 9 (45%) had AKIN 3. They required inotropes, prolonged mechanical ventilation and staying in intensive care. The use of aminoglycosides in the postoperative period did not have a significant impact on the emerge of AKI.
Conclusions. Newborns are at high risk of developing acute kidney injury after repair of congenital heart defects. Critical preoperative health condition and special features of surgical intervention in this pathology introduce the danger of a damaging effect on the kidneys. Throughout the study of this problem, we came to the conclusion that in the postoperative period patients with acute kidney injury require longer mechanical ventilation, inotropic support; they prolong the length of stay in the intensive care unit and, in general, the length of hospitalization, and have the high risk of death.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee (LEC) of institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors
Key words: acute kidney injury, cardiopulmonary bypass, coarctation of the aorta, congenital heart disease.
REFERENCES
1. Chernyshuk SS, Vysotskyi AD, Chasovskyi KS, Zhovnir VA. (2013). Dosvid zastosuvannia perytonealnoho dializu u ditei pislia kardiokhirurhichnykh vtruchan. Sertsevo4sudynna khirurhiia. Shchorichnyk naukovykh prats Asotsiatsii sertsevosudynnykh khirurhiv Ukrainy. 21: 553-556.
2. Alkandari O, Eddington KA, Hyder A, Gauvin F et al. (2011). Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two4center retrospective cohort study. Crit Care Med. 15(3): R146. https://doi.org/10.1186/cc10269; PMid:21663616 PMCid:PMC3219018
3. Andreoli SP. (2009). Acute kidney injury in children. Pediatric nephrology. 24: 253–263. https://doi.org/10.1007/s00467-008-1074-9; PMid:19083019 PMCid:PMC2756346
4. Aydin SI, Seiden HS, Blaufox AD, Parnell VA, Choudhury T, Punnoose A et al. (2012). Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg. 94: 1589–1595. https://doi.org/10.1016/j.athoracsur.2012.06.050; PMid:22884599
5. Blinder JJ, Goldstein SL, Lee VV. (2012). Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg. 143: 368–374. https://doi.org/10.1016/j.jtcvs.2011.06.021; PMid:21798562
6. Fadel FI, Abdel Rahman Amo, Mohamed MF et al. (2012). Plasma neutrophil gelatinase4associated lipocalin as an early biomarker for prediction of acute kidney injury after cardio-pulmonary bypass in pediatric cardiac surgery. Arch Med Sci. 8(2): 250–255. https://doi.org/10.5114/aoms.2012.28552; PMid:22661997 PMCid:PMC3361037
7. Kavaz A, Ozcakar ZB, Kendirli T et al. (2012). Acute kidney injury in a paediatric intensive care unit: comparison of the pRIFLE and AKIN criteria. Acta Paediatr. 101(3): 126–129. https://doi.org/10.1111/j.1651-2227.2011.02526.x; PMid:22077269
8. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. (2012). Kidney inter. 2: 1–138.
9. Krawczeski CD, Woo JG, Wang Y et al. (2011). Neutrophil gelatinase-associated lipocalin concentrations predict development of acute kidney injury in neonates and children after cardiopulmonary bypass. J Pediatr. 158: 1009–1015. https://doi.org/10.1016/j.jpeds.2010.12.057; PMid:21300375
10. Li S, Krawczeski CD, Zappitelli M et al. (2011). Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med. 39: 1493–1499. https://doi.org/10.1097/CCM.0b013e31821201d3; PMid:21336114 PMCid:PMC3286600
11. Morgan CJ, Zappitelli M, Robertson CM, Alton GY, Sauve RS, Joffe AR et al. (2013). Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr. 162: 120–127. https://doi.org/10.1016/j.jpeds.2012.06.054; PMid:22878115
12. Pedersen KR, Povlsen JV, Christensen S et al. (2007). Risk factors for acute renal failure requiring dialysis after surgery for congenital heart disease in children. Acta Anaesthesiol Scand. 51: 1344–1349. https://doi.org/10.1111/j.1399-6576.2007.01379.x; PMid:17944638
13. Schneider J, Khemani R, Grushkin C et al. (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: 933–939. https://doi.org/10.1097/CCM.0b013e3181cd12e1; PMid:20124891
14. Taylor ML, Carmona F, Thiagarajan RR, Westgate L et al. (2013). Mild postoperative acute kidney injury and outcomes after surgery for congenital heart disease. J Thorac Cardiovasc Surg.146: 146–152. https://doi.org/10.1016/j.jtcvs.2012.09.008; PMid:23040323
15. Toth R, Breuer T, Cserep Z et al. (2012). Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients under-going heart surgery. Ann Thorac Surg. 93(6): 1984–1990. https://doi.org/10.1016/j.athoracsur.2011.10.046; PMid:22226235
16. Woo Sung Jang, Woong-Hun Kim, Kwangho Choi et al. (2014). Incidence, risk factors and clinical outcomes for acute kidney injury after aortic arch repair in paediatric patients. Eur J Cardiо-Thorac Surg. 45: 208–214. https://doi.org/10.1093/ejcts/ezu132; PMid:24682871
17. Zappitelli M, Bernier PL, Saczkowski RS, Tchervenkov CI et al. (2009). A small postoperative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney Int. 7: 885–892. https://doi.org/10.1038/ki.2009.270; PMid:19641482