PDF(Pubmed)
Abstract：
OBJECTIVE: Pediatric acute kidney injury (AKI) is a prevalent and morbid complication of shock. Its pathogenesis and early identification remain elusive.
OBJECTIVE: We aim to determine whether renal blood flow (RBF) measurements by point-of-care ultrasound (POCUS) and renin-angiotensin-aldosterone system (RAAS) hormones in pediatric shock associate with vasoactive requirements and AKI.
METHODS: This is a single-center prospective, noninterventional observational cohort study in one tertiary PICU in North American from 2020 to 2022 that enrolled children younger than 18 years with shock without preexisting end-stage renal disease.
METHODS: RBF was measured by POCUS on hospital days 1 and 3 and plasma RAAS hormone levels were measured on day 1. The primary outcome was the presence of AKI by Kidney Disease Improving Global Outcomes criteria at first ultrasound with key secondary outcomes of creatinine, blood urea nitrogen (BUN), Vasoactive-Inotrope Score (VIS), and norepinephrine equivalent dosing (NED) 48 hours after first ultrasound.
RESULTS: Fifty patients were recruited (20 with AKI, mean age 10.5 yr, 48% female). POCUS RBF showed lower qualitative blood flow (power Doppler ultrasound [PDU] score) and higher regional vascular resistance (renal resistive index [RRI]) in children with AKI (p = 0.017 and p = 0.0007). Renin and aldosterone levels were higher in the AKI cohort (p = 0.003 and p = 0.007). Admission RRI and PDU associated with higher day 3 VIS and NED after adjusting for age, day 1 VIS, and RAAS hormones. Admission renin associated with higher day 3 creatinine and BUN after adjusting for age, day 1 VIS, and the ultrasound parameters.
CONCLUSIONS: In pediatric shock, kidney blood flow was abnormal and renin and aldosterone were elevated in those with AKI. Kidney blood flow abnormalities are independently associated with future cardiovascular dysfunction; renin elevations are independently associated with future kidney dysfunction. Kidney blood flow by POCUS may identify children who will have persistent as opposed to resolving AKI. RAAS perturbations may drive AKI in pediatric shock.
OBJECTIVE: We aim to determine whether renal blood flow (RBF) measurements by point-of-care ultrasound (POCUS) and renin-angiotensin-aldosterone system (RAAS) hormones in pediatric shock associate with vasoactive requirements and AKI.
METHODS: This is a single-center prospective, noninterventional observational cohort study in one tertiary PICU in North American from 2020 to 2022 that enrolled children younger than 18 years with shock without preexisting end-stage renal disease.
METHODS: RBF was measured by POCUS on hospital days 1 and 3 and plasma RAAS hormone levels were measured on day 1. The primary outcome was the presence of AKI by Kidney Disease Improving Global Outcomes criteria at first ultrasound with key secondary outcomes of creatinine, blood urea nitrogen (BUN), Vasoactive-Inotrope Score (VIS), and norepinephrine equivalent dosing (NED) 48 hours after first ultrasound.
RESULTS: Fifty patients were recruited (20 with AKI, mean age 10.5 yr, 48% female). POCUS RBF showed lower qualitative blood flow (power Doppler ultrasound [PDU] score) and higher regional vascular resistance (renal resistive index [RRI]) in children with AKI (p = 0.017 and p = 0.0007). Renin and aldosterone levels were higher in the AKI cohort (p = 0.003 and p = 0.007). Admission RRI and PDU associated with higher day 3 VIS and NED after adjusting for age, day 1 VIS, and RAAS hormones. Admission renin associated with higher day 3 creatinine and BUN after adjusting for age, day 1 VIS, and the ultrasound parameters.
CONCLUSIONS: In pediatric shock, kidney blood flow was abnormal and renin and aldosterone were elevated in those with AKI. Kidney blood flow abnormalities are independently associated with future cardiovascular dysfunction; renin elevations are independently associated with future kidney dysfunction. Kidney blood flow by POCUS may identify children who will have persistent as opposed to resolving AKI. RAAS perturbations may drive AKI in pediatric shock.
摘要：
目的：小儿急性肾损伤（AKI）是休克的一种普遍和病态的并发症。其发病机制和早期鉴定仍然难以捉摸。
目的：我们的目的是确定在小儿休克中通过即时超声（POCUS）和肾素-血管紧张素-醛固酮系统（RAAS）激素进行的肾血流量（RBF）测量是否与血管活性需求和AKI相关。
方法：这是一个单中心前瞻性，2020-2022年在北美一个三级PICU进行的非介入性观察性队列研究,该研究纳入了18岁以下无终末期肾病的休克儿童.
方法：在住院第1天和第3天通过POCUS测量RBF，并在第1天测量血浆RAAS激素水平。主要结局是肾脏疾病AKI的存在，首次超声改善全球结局标准，关键次要结局是肌酐。血尿素氮(BUN),血管活性-Inotrope评分（VIS），和去甲肾上腺素等效给药（NED）48小时后第一次超声。
结果：招募了50名患者（20名患有AKI，平均年龄10.5岁，48%女性）。POCUSRBF在AKI患儿中显示出较低的定性血流（功率多普勒超声[PDU]评分）和较高的区域血管阻力（肾阻力指数[RRI]）（p=0.017和p=0.0007）。AKI队列中的肾素和醛固酮水平较高（p=0.003和p=0.007）。调整年龄后，与第3天VIS和NED较高关联的入院RRI和PDU，第1天VIS,和RAAS激素。调整年龄后，入院肾素与第3天肌酐和BUN升高相关，第1天VIS,和超声参数。
结论：在小儿休克中，AKI患者肾血流异常,肾素和醛固酮升高.肾脏血流异常与未来的心血管功能障碍独立相关；肾素升高与未来的肾功能障碍独立相关。POCUS的肾脏血流可能会识别出患有持续性而不是解决AKI的儿童。RAAS扰动可能在小儿休克中驱动AKI。
目的：我们的目的是确定在小儿休克中通过即时超声（POCUS）和肾素-血管紧张素-醛固酮系统（RAAS）激素进行的肾血流量（RBF）测量是否与血管活性需求和AKI相关。
方法：这是一个单中心前瞻性，2020-2022年在北美一个三级PICU进行的非介入性观察性队列研究,该研究纳入了18岁以下无终末期肾病的休克儿童.
方法：在住院第1天和第3天通过POCUS测量RBF，并在第1天测量血浆RAAS激素水平。主要结局是肾脏疾病AKI的存在，首次超声改善全球结局标准，关键次要结局是肌酐。血尿素氮(BUN),血管活性-Inotrope评分（VIS），和去甲肾上腺素等效给药（NED）48小时后第一次超声。
结果：招募了50名患者（20名患有AKI，平均年龄10.5岁，48%女性）。POCUSRBF在AKI患儿中显示出较低的定性血流（功率多普勒超声[PDU]评分）和较高的区域血管阻力（肾阻力指数[RRI]）（p=0.017和p=0.0007）。AKI队列中的肾素和醛固酮水平较高（p=0.003和p=0.007）。调整年龄后，与第3天VIS和NED较高关联的入院RRI和PDU，第1天VIS,和RAAS激素。调整年龄后，入院肾素与第3天肌酐和BUN升高相关，第1天VIS,和超声参数。
结论：在小儿休克中，AKI患者肾血流异常,肾素和醛固酮升高.肾脏血流异常与未来的心血管功能障碍独立相关；肾素升高与未来的肾功能障碍独立相关。POCUS的肾脏血流可能会识别出患有持续性而不是解决AKI的儿童。RAAS扰动可能在小儿休克中驱动AKI。
