nach oben

13.05.2024 | Original Article

Renal resistive index by point of care ultrasound to predict sepsis associated acute kidney injury in critically ill children

verfasst von: Muthuvel Rajangam, Karthi Nallasamy, Anmol Bhatia, Vinod Kumar, Prabhjot Kaur, Suresh Kumar Angurana

Einloggen, um Zugang zu erhalten

Abstract

Background

Sepsis associated acute kidney injury (AKI) is linked with adverse outcomes in the PICU. Doppler-based renal resistive index (RRI) has shown promising results in adults for prediction of AKI. We aimed to explore the performance of RRI in children with sepsis.

Methods

This prospective observational study (March – November 2022) included children aged 1–12 years with sepsis admitted to the PICU. RRI and urine neutrophil gelatinase associated lipocalin (NGAL) were measured within 12 h of admission. Children were followed up for 3 days. AKI (new and persistent) was defined as any child with KDIGO stage 2 or 3 AKI on day 3.

Results

We enrolled 90 children but included 79 in final analysis. Two thirds (n = 53, 67%) had septic shock. Median (IQR) age was 6.2 years (4.1–9.2). RRI decreased with increasing age. Twenty-six (33%) children had AKI on day 3. Mean (SD) RRI was higher in the AKI group [0.72 (0.08) vs. 0.65 (0.07), p < 0.001].The area under ROC curve for RRI to detect AKI among the 1–4 year old group was 0.75 (95% CI:0.51, 0.98; p = 0.05) and among the 5–12 year old group was 0.76 (0.62, 0.89; p = 0.001). An RRI 0.71 predicted AKI with 100% sensitivity and 46.2% specificity among the 1–4-year-old group and RRI 0.69 predicted it with 70% sensitivity and 77.5% specificity in the 5–12-year-old group. RRI and eGFR at admission were independent predictors of AKI on multivariable analysis. Urine NGAL 94.8 ng/ml predicted AKI with 76.9% sensitivity and 77.4% specificity and AUROC was 0.74 (0.62, 0.86) among the 1–12-year-old group.

Conclusions

RRI values varied with age. RRI showed good diagnostic accuracy to detect new/persistent AKI on day 3 in children with sepsis; however, it was less precise as an independent predictor.

Graphical abstract

Nur mit Berechtigung zugänglich

Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL et al (2017) Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med 376:11–20CrossRef

Selewski DT, Cornell TT, Heung M, Troost JP, Ehrmann BJ, Lombel RM et al (2014) Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population. Intensive Care Med 40:1481–1488CrossRefPubMed

Fitzgerald JC, Basu RK, Akcan-Arikan A, Izquierdo LM, Pineres Olave BE, Hassinger AB et al (2016) Acute kidney injury in pediatric severe sepsis: an independent risk factor for death and new disability. Crit Care Med 44:2241–2250CrossRefPubMedPubMedCentral

Hall PS, Mitchell ED, Smith AF, Cairns DA, Messenger M, Hutchinson M et al (2018) The future of diagnostic tests of acute kidney injury in critical care: evidence synthesis, care pathway analysis and research prioritization. Health Technol Assess 22:1–274CrossRefPubMedPubMedCentral

Alobaidi R, Basu RK, Goldstein SL, Bagshaw SM (2015) Sepsis-associated acute kidney injury. Semin Nephrol 35:2–11CrossRefPubMedPubMedCentral

Starr MC, Banks R, Reeder RW, Fitzgerald JC, Pollack MM, Meert KL et al (2020) Severe acute kidney injury is associated with increased risk of death and new morbidity after pediatric septic shock. Pediatr Crit Care Med 21:e686–e695CrossRefPubMedPubMedCentral

Haitsma Mutlier JLG, Rozemeijier S, Roettgering JG, Spoelstra-de Man AME, Elbers PWG, Tuinman PR et al (2018) Renal resistive index as an early predictor and discriminator of acute kidney injury in critically ill patients; a prospective observational cohort study. PLoS One 13:e0197967. https://doi.org/10.1371/journal.pone.0197967CrossRef

Goldstein B, Giroir B, Randolph A (2005) International Consensus Conference on Pediatric sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6:2–8. https://doi.org/10.1097/01.PCC.0000149131.72248.E6

Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group (2012) KDIGO clinical practice guidelines on acute kidney injury. Kidney Int Suppl 2:1–138

10.

Basu RK, Hackbarth R, Gillespie S, Akcan Arikan A, Brophy P, Bagshaw S et al (2021) Clinical phenotypes of acute kidney injury are associated with unique outcomes in critically ill septic children. Pediatr Res 90:1031–1038CrossRefPubMedPubMedCentral

11.

Vade A, Subbaiah P, Kalbhen CL, Ryva JC (1993) Renal resistive indices in children. J Ultrasound Med 12:655–658CrossRefPubMed

12.

Bude RO, DiPietro MA, Platt JF, Rubin JM, Miesowicz S, Lundquist C (1992) Age dependency of the renal resistive index in healthy children. Radiology 184:469–473CrossRefPubMed

13.

Kuzmic AC, Brkljacic B, Ivankovic D, Galesic K (2000) Doppler sonographic renal resistive index in healthy children. Eur Radiol 10:1644–1648. https://doi.org/10.1007/s003300000466

14.

Sigirci A, Hallac T, Akyncy A, Temel I, Gulcan H, Aslan M, Kocer M, Kahraman B, Alkan A, Kutlu R (2006) Renal interlobar artery parameters with duplex doppler sonography and correlation with age, plasma renin and aldosterone levels in healthy children. AJR Am J Roentgenol 186:828–832CrossRef

15.

Post EH, Kellum JA, Bellomo R, Vincent JL (2017) Renal perfusion in sepsis: from macro- to microcirculation. Kidney Int 91:45–60. https://doi.org/10.1016/j.kint.2016.07.032CrossRefPubMed

16.

De Carvalho AV, Ferraz IS, de Souza FM, Brandao MD, Nogueira RJN, Alves DFS et al (2023) Acute kidney injury in critically ill children: predictive value of renal arterial Doppler assessment. Pediatr Res 93:1694–1700. https://doi.org/10.1038/s41390-022-02296-1CrossRefPubMed

17.

Sharkey RA, Mulloy EM, Long M, O’Neill SJ (1999) The effect of continuous positive airway pressure (CPAP) on renal vascular resistance: the influence of renal denervation. Crit Care 3:33–37CrossRefPubMedPubMedCentral

18.

Fu Y, He C, Jia L, Ge C, Long L, Bai Y et al (2022) Performance of renal resistive index and usual clinical indicators in predicting persistent AKI. Ren Fail 44:2028–2038CrossRefPubMedPubMedCentral

19.

Darmon M, Bourmaud A, Reynaud M, Rouleau S, Meziani F, Boivin A et al (2018) Performance of Doppler-based resistive index and semi-quantitative renal perfusion in predicting persistent AKI: results of a prospective multicenter study. Intensive Care Med 44:1904–1913CrossRefPubMed

20.

Tublin ME, Tessler FN, Murphy ME (1999) Correlation between renal vascular resistance, pulse pressure and the resistive index in isolated perfused rabbit kidneys. Radiology 213:258–264CrossRefPubMed

21.

Tanimura M, Dohi K, Matsuda M, Sato Y, Suigura E, Kumagai N et al (2015) Renal resistive index as an indicator of the presence and severity of anemia and its future development in patients with hypertension. BMC Nephrol 16:45CrossRefPubMedPubMedCentral

22.

Sharkey RA, Mulloy EM, O’Neill SJ (1999) The acute effects of oxygen and carbon dioxide on renal vascular resistance in patients with an acute exacerbation of COPD. Chest 115:1588–1592CrossRefPubMed

23.

Ngai CW, Lam MF, Lo SH, Cheung CW, Chan WM (2011) Use of Doppler ultrasound renal resistive index and neutrophil gelatinase associated lipocalcin in prediction of acute kidney injury in patients with septic shock. Crit Care 15:P108CrossRefPubMedCentral

24.

Dawood HF, Fouad HA, El-Shafei MM, Hussein HW, Razek AA (2022) Renal Resistive Index (RRI) Versus Urinary Neutrophil Gelatinase Associated Lipocalin (uNGAL) in adults undergoing elective cardiac surgeries with cardiopulmonary bypass: A prospective randomized observational study. Egypt J Anaesth 38:166–173CrossRef

25.

Bagshaw SM, Bennett M, Haase M, Haase-Fielitz A, Egi M, Morimatsu H et al (2010) Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness. Intensive Care Med 36:452–461CrossRefPubMed

26.

Zhang A, Cai Y, Wang PF, Qu JN, Luo ZC, Chen XD et al (2016) Diagnosis and prognosis of neutrophil gelatinase-associated lipocalin for acute kidney injury with sepsis: a systematic review and meta-analysis. Crit Care 20:41CrossRefPubMedPubMedCentral

27.

Kapalavai SK, Ramachandran B, Krupanandan R, Sadasivam K (2022) Usefulness of Urinary Neutrophil Gelatinase-associated Lipocalcin as a Predictor of Acute Kidney Injury in Critically Ill Children. Indian J Crit Care Med 26:634–638CrossRefPubMedPubMedCentral

28.

Tornblom S, Nisula S, Petaja L et al (2020) Urine NGAL as a biomarker for septic AKI: a critical appraisal of clinical utility – data from the observational FINNAKI study. Ann Intensive Care 10:51CrossRefPubMedPubMedCentral

29.

Martensson J, Bellomo R (2014) The Rise and Fall of NGAL in Acute Kidney Injury. Blood Purif 37:304–310CrossRefPubMed

Titel: Renal resistive index by point of care ultrasound to predict sepsis associated acute kidney injury in critically ill children
verfasst von: Muthuvel Rajangam
Karthi Nallasamy
Anmol Bhatia
Vinod Kumar
Prabhjot Kaur
Suresh Kumar Angurana
Publikationsdatum: 13.05.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-024-06392-8

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Renal resistive index by point of care ultrasound to predict sepsis associated acute kidney injury in critically ill children

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

Neu im Fachgebiet Pädiatrie

Ähnliche Überlebensraten nach Reanimation während des Transports bzw. vor Ort

Alter der Mutter beeinflusst Risiko für kongenitale Anomalie

Begünstigt Bettruhe der Mutter doch das fetale Wachstum?

Bei Amblyopie früher abkleben als bisher empfohlen?

Update Pädiatrie

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Neu im Fachgebiet Pädiatrie

Ähnliche Überlebensraten nach Reanimation während des Transports bzw. vor Ort

Alter der Mutter beeinflusst Risiko für kongenitale Anomalie

Begünstigt Bettruhe der Mutter doch das fetale Wachstum?

Bei Amblyopie früher abkleben als bisher empfohlen?

Update Pädiatrie