Early diagnosis of acute kidney injury in children with poisoning of chemical etiology

Abstract

Purpose. The study aims at optimizing the diagnosis of acute kidney injury in children with poisoning of chemical etiology based on the use of early markers of kidney damage.Materials and Methods. The study enrolled 120 patients aged 1–18 years with poisoning of chemical etiology. Routine methods of kidney function estimation were supplemented by an investigation of urinary concentration of acute kidney injury early markers: lipocalin-2, kidney injury molecule-1. All children were hospitalized in a toxicology unit on the 1st day after exposure to toxic substance. Twenty practically healthy children aged 1–18 years were examined as control group.Results. Only one patient (0.8%) had acute kidney injury determined as increased serum creatinine at the time of admission, but at the same time 35 children (29.2%) had increased levels of one or more urinary markers. By the 3rd day 32 of those 35 children with increased urinary markers developed acute kidney injury stages 1 or 2, determined as significant rise of serum creatinine and decrease of renal blood flow according to Doppler ultrasound. On the contrary, no patient with initially normal level of urinary markers developed acute kidney injury. Thus, 32/120 patients hospitalized with poisoning of chemical etiology, developed acute kidney injury (26.7%).Conclusion. Increased urinary excretion of lipocalin-2 and kidney injury molecule-1 at the first day of acute chemical poisoning can be estimated as predictive marker of acute kidney injury development.