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CC BY 4.0 · Brazilian Journal of Oncology 2022; 18: e-20220291
DOI: 10.5935/2526-8732.20220291
Original Article
Clinical Oncology

Acute kidney injury in children with cancer admitted in an intensive care unit

Lesão renal aguda em crianças com câncer internadas em unidade de terapia intensiva
Jáder Pereira Almeida 
1   Santa Casa de Belo Horizonte, Terapia Intensiva Pediátrica - Belo Horizonte - Minas Gerais - Brazil
,
Gabriela Caus Fernandes Luiz
2   Hospital Infantil Pequeno Príncipe, Oncologia Pediátrica - Curitiba - Paraná - Brazil
,
Scheilla Torres De-Oliveira
3   Santa Casa de Belo Horizonte, Oncologia Pediátrica - Belo Horizonte - Minas Gerais - Brazil
,
Larissa Nicolini De-Santa
4   Universidade Positivo, Faculdade de Medicina - Curitiba - Paraná - Brazil
,
Giovanna Soldatelli Borsato
5   Pontifícia Universidade Católica do Paraná, Faculdade de Medicina - Curitiba - Paraná - Brazil
,
Paulo Ramos David João
6   Hospital Infantil Pequeno Príncipe, Terapia Intensiva Pediátrica - Curitiba - Paraná - Brazil
› Author Affiliations Financial support: None to declare.
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ABSTRACT

Objective: Evaluating the association between acute kidney injury and death in critically ill children with oncological diseases admitted in an intensive care unit (ICU).

Material and Methods: Unicentric cohort study, evolving children with cancer admitted in the ICU of a pediatrics referral hospital. The patients were divided according to the presence or absence of acute kidney injury. Patients with a history of urogenital disease, nephrectomy or chronic kidney disease were excluded. The acute kidney injury was defined by the Kidney Disease Improving Global Outcomes (KDIGO) classification. The main outcome was death.

Results: The sample was composed of 84 patients, in which 46.4% were diagnosed with hematologic neoplasm, 29.8% evolved with febrile neutropenia, 11.9% had a history of bone marrow transplant, and 27.3% deceased. Acute kidney injury occurred in 51.2% of the sample, 53.6% used furosemide, 38% showed fluid overload, and 8.3% had renal replacement therapy. The main variables related to kidney dysfunction were admission due to hemodynamic shock, pediatric risk of mortality score 2 ≥5%, bone marrow transplant, volume overload and multiple organ dysfunction syndrome. More advanced stages of acute kidney injury were associated with renal replacement therapy (p<0.001), longer stay in the ICU (p=0.006), and death (p=0.003).

Conclusion: Children with cancer showed many risk factors of acute kidney injury, and this complication is associated with higher death rate.

RESUMO

Objetivo: Avaliar a associação entre lesão renal aguda e óbito em crianças com doenças oncológicas criticamente enfermas internadas em uma unidade de terapia intensiva (UTI).

Material e Métodos: Estudo de coorte unicêntrico, envolvendo crianças com câncer internadas na UTI de um hospital de referência em pediatria. Os pacientes foram divididos de acordo com a presença ou ausência de lesão renal aguda. Pacientes com história de doença urogenital, nefrectomia ou doença renal crônica foram excluídos. A lesão renal aguda foi definida pela classificação do Kidney Disease Improving Global Outcomes (KDIGO). O desfecho principal foi a morte.

Resultados: A amostra foi composta por 84 pacientes, em que 46,4% foram diagnosticados com neoplasia hematológica, 29,8% evoluíram com neutropenia febril, 11,9% tinham histórico de transplante de medula óssea e 27,3% foram a óbito. A lesão renal aguda ocorreu em 51,2% da amostra, 53,6% usaram furosemida, 38% apresentaram sobrecarga hídrica e 8,3% fizeram terapia renal substitutiva. As principais variáveis relacionadas à disfunção renal foram admissão por choque hemodinâmico, escore pediatric risk of mortality 2 ≥5%, transplante de medula óssea, sobrecarga de volume e síndrome de disfunção de múltiplos órgãos. Estágios mais avançados de lesão renal aguda foram associados à terapia renal substitutiva (p<0,001), maior permanência na UTI (p=0,006) e óbito (p=0,003).

Conclusão: Crianças com câncer apresentaram muitos fatores de risco de lesão renal aguda, e esta complicação está associada a uma maior taxa de mortalidade.

Keywords:

Acute kidney injury - Pediatric intensive care units - Medical oncology - Child - Multiple organ failure

Palavras-chave:

Lesão renal aguda - Unidades de Terapia Intensiva Pediátrica - Oncologia médica - Criança - Falência de múltiplos órgãos


Publication History

Received: 10 August 2021

Accepted: 19 February 2022

Article published online:
22 June 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Jáder Pereira Almeida, Gabriela Caus Fernandes Luiz, Scheilla Torres De-Oliveira, Larissa Nicolini De-Santa, Giovanna Soldatelli Borsato, Paulo Ramos David João. Acute kidney injury in children with cancer admitted in an intensive care unit. Brazilian Journal of Oncology 2022; 18: e-20220291.
DOI: 10.5935/2526-8732.20220291
 

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