Acute Kidney Injury Associated With Urinary Stone Disease in Children and Young Adults Presenting to a Pediatric Emergency Department

Abstract

Background: Acute kidney injury (AKI) due to urinary stone disease (USD) is rare in adults; AKI rates in children with USD may be higher, and emerging data links stones to chronic kidney disease (CKD) development in adults. Methods: This study is a retrospective analysis of USD patients at a single pediatric hospital system's emergency department (ED). Patients were initially identified by USD ICD codes; USD was then confirmed by imaging or physician documentation; patients had to have baseline creatinine (Cr) and Cr in the ED for comparison to be included. AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO), Acute Kidney Injury Network (AKIN), and Pediatric Risk, Injury, Failure, Loss, End Stage (pRIFLE). Results: Of the 589 total visits, 264/589 (45%) had data to evaluate for AKI, 23% were AKI(+) and 77% were AKI(-). pRIFLE was most common (82%) and 18% were only positive by AKIN/KDIGO. AKI(+) were more likely to be younger (16.7 vs. 17.4 years, p = 0.046) and more likely to present with vomiting {odds ratio [OR] [95% confidence interval (CI)]: 2.4 [1.4-4.3], p = 0.002}; also, the proportion of AKI(+) was significantly higher in <18 vs. ≥18 years [26.9 vs. 15.5%, p = 0.032, OR (95% CI): 2.0 (1.1-3.9)]. Urinary tract infection (UTI) and obstruction rates were similar between groups. AKI(+) patients had a significant OR <1 suggesting less risk of receiving non-steroidal anti-inflammatory drugs (NSAIDs); however, 51% of them did receive NSAIDs during their ED encounter. AKI(+) patients were more likely to require admission to the hospital (53 vs. 32%, p = 0.001). Conclusion: We have demonstrated a novel association between USD-induced renal colic and AKI in a group of young adults and children. AKI(+) patients were younger and were more likely to present with vomiting. AKI(+) patients did not have higher rates of obstruction or UTI, and 51% of AKI(+) received NSAIDs.

Keywords: AKI; kidney stones; pediatric; urinary stone disease (USD); urolithiasis.

Figure 1

Inclusion and exclusion of patient visits. AKI, acute kidney injury; ED, emergency department.

Figure 2

Comparative stages of AKI. AKIN, Acute Kidney Injury Network; KDIGO, Kidney Disease Improving Global Outcomes; PRIFLE, Pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease.

Figure 3

Recognition of AKI by stage. (A) Dark gray: no documentation. (B) Medium gray: documentation of abnormal labs. (C) Light gray: documentation of the presence of AKI or elevated Cr in assessment and/or plan. AKI stage is chosen by the highest stage met of any the pRIFLE, AKIN, or KDIGO criteria.

Figure 4

NSAID use by AKI stage. Dark gray: received NSAIDs. Light gray: did not receive NSAIDs. AKI stage is chosen by the highest stage met of any the pRIFLE, AKIN, or KDIGO criteria. NSAID, non-steroidal anti-inflammatory drug.