Documento de consenso: recomendaciones sobre la utilización de ecuaciones para la estimación del filtrado glomerular en niños

[Basal renal function in paediatric patients: correlation of methods that depend on a 24h urine collection with simpler methods that do not require a timed urine]

INTRODUCTION

In daily clinical practice a quick, easy and accessible method is needed to adequately assess renal function. The objectives of this study were: 1. To quantify the relationship and concordance of the glomerular filtration rate (GF) calculated by the clearance of creatinine in 24h urine (CCr) and the original and modified Schwartz equation (SE); and 2. To correlate urine elimination of substances that depends on the volume of excreted urine in a unit of time with other parameters that are calculated measuring the concentration of these substances in blood and urine.

MATERIAL AND METHODS

The study included 401 healthy children with ages between 3 to 14 years (187 male and 214 female). The analysis between the variables was carried out using Pearson's correlation coefficient and the intraclass correlation coefficient (ICC).

RESULTS

The correlation between values of CCr and the original SE (non-standardised creatinine measurement) was r=0.58 (P<0.001) and the concordance, ICC=0.74. The correlation between CCr values and the modified SE (standardised creatinine measurement) was r=0.68 (P<.001), and the concordance ICC=0.78. There was a very significant correlation between the elimination of sodium in a 24h urine (mEq/kg/24h) and the Na-Fractional-Excretion (EFNa): r=0.8 (P<.001). There was a correlation between the potassium elimination in 24h (mEq/kg/24h) and EFK: r=0.85 (P<.001). Between volume/min/1.73m² and the urine volume percent of GF was: r=0.88 (P<.001).

CONCLUSIONS

These equations provide valuable information of the state of the basal renal function without having to use a timed urine.

[Severe acute kidney injury in critically ill children: Epidemiology and prognostic factors]

INTRODUCTION

Acute kidney injury (AKI) is a severe complication in critically ill children. The aim of the study was to describe the characteristics of AKI, as well as to analyse the prognostic factors for mortality and renal replacement therapy (RRT) in children admitted to Paediatric Intensive Care Units (PICUs) in Spain.

PATIENTS AND METHODS

Prospective observational multicentre study including children from 7 days to 16 years old who were admitted to a PICU. A univariate and multivariate logistic regression analysis of the risk factors for mortality and renal replacement therapy at PICU discharge were performed.

RESULTS

A total of 139 cases of AKI were analysed. RRT was necessary in 60.1% of cases. Mortality rate was 32.6%. At PICU discharge RRT was necessary in 15% of survivors. Thrombopenia and low creatinine clearance values were prognostic markers of RRT at PICU discharge. High values of platelets, serum creatinine and weight were associated with higher survival.

CONCLUSIONS

Critically ill children with AKI had a high mortality and morbidity rate. Platelet values and creatinine clearance are markers of RRT at PICU discharge, whereas number of platelets, serum creatinine and weight were associated with mortality.