Risk factors for acute kidney injury at presentation among children with CNS malaria: a case control study.
Risk factors for acute kidney injury at presentation among children with CNS malaria: a case control study.
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DOI：
10.1186/s12936-022-04327-y
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发表时间：
2022-11-01
期刊：
影响因子：
3
通讯作者：
Birbeck, Gretchen L.
中科院分区：
文献类型：
--
作者：
Tembo, Derby;Mwanza, Suzanna;Mwaba, Chisambo;Dallah, Ifunanya;Somwe, Somwe Wa;Seydel, Karl B.;Birbeck, Gretchen L.
最近的研究表明，急性肾损伤(AKI)是严重的儿科疟疾的常见问题。在疟疾常见的低资源环境中，获得肾脏诊断研究的机会有限，这限制了对这一重要问题的研究。一项正在进行的中枢神经系统(CNS)疟疾儿童退热药临床试验的登记数据被用来确定AKI的危险因素。对患有中枢神经系统疟疾的2-11岁儿童进行了筛查和登记评估，其中包括人口学和拟人化数据、有关急性疾病的临床细节以及实验室研究，包括肌酐(Cr)、定量寄生虫计数(QPC)、定量组氨酸丰富蛋白2(HRP2)、乳酸和胆红素水平。由于研究药物的潜在肾毒性作用，具有筛查Cr >； 106微克分子/L的儿童被排除在研究之外。为了在入院时确定AKI的风险因素，根据2012年肾脏疾病：改善全球预后(KDIGO)指南，根据他们的基线(即，在这种急性疾病之前)的估计将纳入研究的儿童归类为AKI患者。Logistic回归和多变量模型被用来确定在参加研究的儿童中出现AKI的临床和人口学危险因素。筛查465名儿童，其中377名为中枢神经系统疟疾适龄儿童，22名(5.8%)因Cr >； 106g/g/L而被排除，209名入选。在209例中，134例(64.1%)符合KDIGO标准的AKI。一名儿童在康复期间需要透析。Logistic回归模型和多因素模型中AKI的危险因素包括：高热(OR 3.36；95%CI 1.39~8.12)和年龄较大的儿童患AKI的可能性较小(OR 0.72；95%CI 0.62~0.84)。AKI在患有中枢神经系统疟疾的儿童中非常常见。高热和相关的脱水可能是AKI的原因之一，也可能只是更具炎症性的全身反应的标志，这也会影响肾脏。对患有中枢神经系统疟疾和急性肾损伤的儿童进行适当的液体管理可能是具有挑战性的，因为在这一危重人群中，大量水化以支持肾脏恢复可能会加剧疟疾引起的脑水肿。试用注册https://clinicaltrials.gov/ct2/show/NCT03399318
Recent research has established that acute kidney injury (AKI) is a common problem in severe paediatric malaria. Limited access to kidney diagnostic studies in the low resources settings where malaria is common has constrained research on this important problem. Enrolment data from an ongoing clinical trial of antipyretics in children with central nervous system (CNS) malaria, CNS malaria being malaria with seizures or coma, was used to identify risk factors for AKI at presentation. Children 2–11 years old with CNS malaria underwent screening and enrollment assessments which included demographic and anthropomorphic data, clinical details regarding the acute illness, and laboratory studies including creatinine (Cr), quantitative parasite count (qPC), quantitative histidine rich protein 2 (HRP2), lactate, and bilirubin levels. Children with a screening Cr > 106 µmol/l were excluded from the study due to the potential nephrotoxic effects of the study drug. To identify risk factors for AKI at the time of admission, children who were enrolled in the study were categorized as having AKI using estimates of their baseline (i.e. before this acute illness) kidney function and creatinine at enrollment applying the Kidney Disease: Improving Global Outcome (KDIGO) 2012 guidelines. Logistic regressions and a multivariate model were used to identify clinical and demographic risk factors for AKI at presentation among those children enrolled in the study. 465 children were screened, 377 were age-appropriate with CNS malaria, 22 (5.8%) were excluded due to Cr > 106 µmol/l, and 209 were enrolled. Among the 209, AKI using KDIGO criteria was observed in 134 (64.1%). One child required dialysis during recovery. Risk factors for AKI in both the logistic regression and multivariate models included: hyperpyrexia (OR 3.36; 95% CI 1.39–8.12) and age with older children being less likely to have AKI (OR 0.72; 95% CI 0.62–0.84). AKI is extremely common among children presenting with CNS malaria. Hyperpyrexia with associated dehydration may contribute to the AKI or may simply be a marker for a more inflammatory systemic response that is also affecting the kidney. Appropriate fluid management in children with CNS malaria and AKI may be challenging since generous hydration to support kidney recovery could worsen malaria-induced cerebral oedema in this critically ill population. Trial registration https://clinicaltrials.gov/ct2/show/NCT03399318
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影响因子：
3
作者：
Plewes K;Royakkers AA;Hanson J;Hasan MM;Alam S;Ghose A;Maude RJ;Stassen PM;Charunwatthana P;Lee SJ;Turner GD;Dondorp AM;Schultz MJ
通讯作者：
Schultz MJ
DOI：
10.1016/j.trstmh.2009.03.001
发表时间：
2009-07
影响因子：
2.2
作者：
Maude RJ;Beare NA;Abu Sayeed A;Chang CC;Charunwatthana P;Faiz MA;Hossain A;Yunus EB;Hoque MG;Hasan MU;White NJ;Day NP;Dondorp AM
通讯作者：
Dondorp AM
影响因子：
3.9
作者：
Plewes K;Turner GDH;Dondorp AM
通讯作者：
Dondorp AM
影响因子：
48
作者：
Birbeck, Gretchen L.;Molyneux, Malcolm E.;Taylor, Terrie E.
通讯作者：
Taylor, Terrie E.
影响因子：
3.3
作者：
Nguansangiam, Sudarat;Day, Nicholas P. J.;Pongponratn, Emsri
通讯作者：
Pongponratn, Emsri