Incidence and risk factors for acute kidney injury in children with nephrotic syndrome: a meta-analysis.

IF 2.1 3区医学 Q2 PEDIATRICS

Frontiers in Pediatrics Pub Date : 2024-12-20 eCollection Date: 2024-01-01 DOI:10.3389/fped.2024.1452568

Changdi Chen, Bingbing Qiu, Jianxin Wang, Liuqing Yang, Yanru Huang

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引用次数: 0

Abstract

Background: Nephrotic syndrome (NS) is a prevalent kidney disease in children. Acute kidney injury (AKI) is a severe complication of NS and has the potential to be life-threatening.

Objective: The aim of this study was to analyze the prevalence and risk factors of AKI in children with NS, and to provide an evidence-based medical basis for the early identification of high-risk children in the clinic.

Methods: A comprehensive search was conducted in publicly available databases, namely PubMed, Embase, Web of Science, Scopus, and the Cochrane Library, covering the period from the inception of each database until May 2024. The analysis involved examining basic characteristics (age, sex), the concomitant diseases (hypertension, infections), NS disease characteristics (steroid susceptibility classification, pathologic classification), laboratory test (e.g., serum albumin), and the use of nephrotoxic drugs. Traditional and network meta-analyses were performed for analysis.

Results: A total of 11 studies were included in the analysis, revealing an incidence of AKI of 29% (95% CI: 23%-37%). The analysis of factors indicated that the age of NS onset [standardized mean difference (SMD): 0.31; 95% confidence interval (CI): 0.08, 0.54; p = 0.009], sex [odds ratio (OR): 1.49; 95% CI: 1.03, 2.16; p = 0.035], serum albumin level (SMD: -0.43; 95% CI: -0.85, -0.02; p = 0.041), response to steroid treatment (OR: 0.52; 95% CI: 0.33, 0.80; p = 0.003), infection (OR: 3.60; 95% CI: 1.91, 6.78; p < 0.001), hypertension (OR: 4.02; 95% CI: 2.94, 5.51; p < 0.001), and nephrotoxic drug application (OR: 4.43; 95% CI: 1.86, 10.53; p = 0.001), were all significantly associated with the incidence of AKI. Furthermore, the results of the network meta-analysis suggested that the pathologic type of minor glomerular abnormalities (MGA)/diffuse mesangial proliferation (DMP), the type of infrequent relapses (IFRNS)/steroid-sensitive NS (SSNS), and the use of diuretic medications were associated with a relatively low risk of AKI occurrence.

Conclusion: Factors upon admission of children with NS are associated with the onset of AKI. Emphasis should be placed on populations with a heightened risk of AKI in clinical practice. Further research is warranted to confirm the findings due to the limitations of this study.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024571170, PROSPERO (CRD42024571170).

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肾病综合征患儿急性肾损伤的发生率和危险因素：一项荟萃分析

背景：肾病综合征（NS）是儿童常见的肾脏疾病。急性肾损伤（AKI）是NS的严重并发症，有可能危及生命。目的：本研究旨在分析NS患儿AKI患病率及危险因素，为临床早期识别高危患儿提供循证医学依据。方法：对PubMed、Embase、Web of Science、Scopus、Cochrane Library等公开数据库进行全面检索，检索时间从各数据库建立至2024年5月。分析包括检查基本特征（年龄、性别）、伴随疾病（高血压、感染）、NS疾病特征（类固醇易感性分类、病理分类）、实验室检查（如血清白蛋白）和肾毒性药物的使用。采用传统meta分析和网络meta分析进行分析。结果：共有11项研究纳入分析，显示AKI的发生率为29% （95% CI: 23%-37%）。因素分析表明：NS发病年龄[标准化平均差（SMD）： 0.31；95%置信区间（CI）： 0.08, 0.54；p = 0.009]，性别[优势比（OR）： 1.49；95% ci: 1.03, 2.16；p = 0.035]，血清白蛋白水平(SMD: -0.43；95% ci: -0.85, -0.02；p = 0.041)，对类固醇治疗的反应(OR: 0.52；95% ci: 0.33, 0.80；p = 0.003)，感染(OR: 3.60；95% ci: 1.91, 6.78；p p p = 0.001)，均与AKI发生率显著相关。此外，网络荟萃分析的结果表明，轻度肾小球异常(MGA)/弥漫性系膜增生（DMP）的病理类型、罕见复发(IFRNS)/类固醇敏感NS （SSNS）的类型以及利尿剂的使用与AKI发生的相对较低风险相关。结论：NS患儿入院时的因素与AKI的发生有关。在临床实践中，重点应放在AKI高风险人群上。由于本研究的局限性，需要进一步的研究来证实这些发现。系统评价注册：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024571170, PROSPERO （CRD42024571170）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Pediatrics Medicine-Pediatrics, Perinatology and Child Health

CiteScore

3.60

自引率

7.70%

发文量

2132

审稿时长

14 weeks

期刊介绍： Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.