Aminophylline Improves Urine Flow Rates but Not Survival in Childhood Oliguric/Anuric Acute Kidney Injury

Introduction: Acute kidney injury (AKI) morbidity and mortality rates remain high. Variable AKI outcomes have been reported in association with aminophylline treatment. This study evaluated AKI outcome in a group of Nigerian children treated with aminophylline.Methods: This is a retrospective study of AKI in children treated with (N=9) and without (N=8) aminophylline. Studied outcome indices comprised urine flow rate (UFR), duration of oliguria/anuria, progression through AKI stages, number of patients requiring dialysis and mortality.Results: Mean ages for the control and aminophylline arms were 4.6±2.7 and 4.9±2.1 years (P=0.7), respectively. All patients progressed to stage-3 AKI. Baseline median UFRs in the aminophylline and control arms were similar (0.13 Vs 0.04 ml/kg/hour respectively, P=0.5). The median UFR was significantly higher on day-5 (0.8 Vs 0.1; P=0.03), day-6 (1.0 Vs 0.2; P=0.02), and day-7 (1.2 Vs 0.2; P=0.03) in the aminophylline than the control arm, respectively. Short duration of oliguria/anuria (≤ 6 days) was more frequently observed in aminophylline- treated patients compared to controls (77.8% Vs 25.0%; odds ratio 0.09; 95% CI: 0.01-0.89; P=0.04). Only the aminophylline group maintained steady serum creatinine levels. Four out of five patients in the control group were dialyzed compared to only one out of eight patients in the aminophylline group (odds ratio 0.16; 95% CI: 0.04-0.71; P=0.03). Mortality rates were similar in aminophylline- treated and control patients (33%Vs 25%; hazard ratio 0.8; 95% CI: 0.1-5.5; P=0.8).Conclusion: Aminophylline therapy was beneficial for patients with AKI in terms of improved UFR and reduced need for dialysis, but failed to impact positively on survival

Epidemiology and Clinicopathologic Outcome of Pediatric Chronic Kidney Disease in Nigeria, a Single Cenetr Study

Introduction: Due to dearth of data, chronic kidney disease (CKD) outcome in African children has been dismal owing to poor understanding of its etiology, manifestations and management.Methods: We retrospectively analyzed the records of 154 CKD children and adolescents who were managed at Obafemi Awolowo University Teaching Hospitals Complex between 2000 and 2009 to evaluate the epidemiology and clinicopathologic outcome of pediatric CKD in Nigeria.Results: Overall mean incidence was 11 (6-20) per million children population (pmcp)/year while prevalence averaged 48 (8-101) pmcp. There were 86 males (55.8%). Median age was 10.0 (0.2-15.5) years with 83.8% . 5 years old. Etiologies were glomerular disease (GMD, 90.26%), congenital and acquired urinary tract (7.79%) and hereditary disorders (1.95%). CKD stages at diagnosis were 45.5% CKD-1, 22.7% CKD-2, 10.4% CKD-3, 2.6% CKD-4 and 18.8% CKD-5. Median progression time through the CKD stages was 24.0 (3-108) months. Mean dialysis incidence and prevalence were 1 (0-4) pmcp/year and 4 (1-12) pmcp, respectively. Hypertension, heart failure (HF), malnutrition, anemia, acute-on-CKD, need for dialysis, azotemia, hypercreatininemia, and high calcium-phosphorous product (. 55 mg2/dL2) were mortality risk factors. CKD-1 survived significantly better than CKD stages 3-5 (p < 0.05) but not CKD-2 (p=0.1). Hypertensive CKDs without HF survived better (73.0%) than hypertensive CKDs with HF (16.0%) [Hazard ratio (HR): 0.34, 95% CI: 0.14-0.83]. GMD survived better (68.5%) than non-GMD patients (33.0%) [HR: 2.87, 95% CI: 1.16-7.06].Conclusion: CKD was commoner among school than pre-school age children. GMD was the predominant etiology with better outcome than non-GMD. Comorbidity prevalence increased significantly with increasing severity of CKD stage.Keywords: Chronic Kidney Disease; Glomerular Disease; Mortality Risk Factors; Nigeri

Acute kidney injury in children

Acute kidney injury (AKI) (previously called acute renal failure) is characterized by a reversible increase in the blood concentration of creatinine and nitrogenous waste products and by the inability of the kidney to regulate fluid and electrolyte homeostasis appropriately. The incidence of AKI in children appears to be increasing, and the etiology of AKI over the past decades has shifted from primary renal disease to multifactorial causes, particularly in hospitalized children. Genetic factors may predispose some children to AKI. Renal injury can be divided into pre-renal failure, intrinsic renal disease including vascular insults, and obstructive uropathies. The pathophysiology of hypoxia/ischemia-induced AKI is not well understood, but significant progress in elucidating the cellular, biochemical and molecular events has been made over the past several years. The history, physical examination, and laboratory studies, including urinalysis and radiographic studies, can establish the likely cause(s) of AKI. Many interventions such as ‘renal-dose dopamine’ and diuretic therapy have been shown not to alter the course of AKI. The prognosis of AKI is highly dependent on the underlying etiology of the AKI. Children who have suffered AKI from any cause are at risk for late development of kidney disease several years after the initial insult. Therapeutic interventions in AKI have been largely disappointing, likely due to the complex nature of the pathophysiology of AKI, the fact that the serum creatinine concentration is an insensitive measure of kidney function, and because of co-morbid factors in treated patients. Improved understanding of the pathophysiology of AKI, early biomarkers of AKI, and better classification of AKI are needed for the development of successful therapeutic strategies for the treatment of AKI