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. 2023 May;38(5):1643-1652.
doi: 10.1007/s00467-022-05735-7. Epub 2022 Oct 13.

Acute kidney injury and diabetic kidney disease in children with acute complications of diabetes

Jolanta Soltysiak  1 , Izabela Krzysko-Pieczka  2 , Anna Gertig-Kolasa  2 , Ewa Mularz  2 , Bogda Skowrońska  2 , Danuta Ostalska-Nowicka  3 , Jacek Zachwieja  3
Affiliations

Acute kidney injury and diabetic kidney disease in children with acute complications of diabetes

Jolanta Soltysiak et al. Pediatr Nephrol. 2023 May.

Abstract

Background: Diabetic ketoacidosis (DKA) and hyperglycaemia without ketoacidosis are common acute complications of diabetes. Their association with acute kidney injury (AKI) and diabetic kidney disease (DKD) was studied.

Methods: The study group consisted of 197 children with type 1 diabetes with average diabetes duration of 8.08 ± 2.32 years. The medical history of the patients was retrospectively reviewed. The number of children with severe hyperglycaemia, DKA and AKI was assessed. The association with the risk of chronic kidney disease (CKD) was analysed.

Results: AKI was found in 14% of cases hospitalised for DKA and 8% of cases hospitalised for hyperglycaemia. Patients with AKI showed a significantly increased corrected sodium (141.23 ± 5.09 mmol/L, p = 0.035). Patients with AKI in DKA showed a significant increase in WBC (20.73 ± 8.71 × 103/µL, p = 0.0009). Follow-up analysis after a minimum of 5 years of diabetes revealed that a single episode of DKA was found in 63 patients and a single episode of AKI in 18 patients. Two or more episodes of DKA were found in 18 patients, and nine cases were complicated by AKI. These patients showed a significant increase in urinary albumin excretion (44.20 ± 64.21 mg/24 h), the highest values of eGFR and the worst glycaemic control.

Conclusions: Diabetic children can develop AKI in the course of DKA and hyperglycaemia without ketoacidosis, which is associated with volume depletion and reflected by corrected sodium concentration. AKI in DKA seems to be complicated by stress and inflammation activation. AKI and poor glycaemic control with repeated DKA episodes can magnify the risk of progression to DKD. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Acute kidney injury; Children; Diabetic ketoacidosis; Diabetic kidney disease.

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Figures

None
A higher resolution version of the Graphical abstract is available as Supplementary information
Fig. 1
Fig. 1
The flow diagram of the study
Fig. 2
Fig. 2
The corrected sodium and WBC levels among groups with acute complications of diabetes. Group N — patients admitted because of hyperglycaemia without DKA; DKA group — patients with DKA; AKIDKA group — patients with AKI during DKA; AKIN — patients with AKI during hyperglycaemia
Fig. 3
Fig. 3
UAE, GFRF, HbA1c and diabetes duration among groups in children after 5 years’ duration of diabetes. Group 0 — patients who had never had DKA; DKA1 — patients with a single episode of DKA during diabetes duration without AKI; AKI1 — patients with a single episode of DKA complicated by AKI; DKAM — patients who had multiple (two or more) episodes of DKA during diabetes duration
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References

    1. Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: challenges, progress, and possibilities. Clin J Am Soc Nephrol. 2017;12:2032–2045. doi: 10.2215/CJN.11491116. - DOI - PMC - PubMed
    1. Afkarian M (2015) Diabetic kidney disease in children and adolescents. Pediatr Nephrol 30:65–74; quiz 70–71. 10.1007/s00467-014-2796-5 - PMC - PubMed
    1. Pulgaron ER, Delamater AM. Obesity and type 2 diabetes in children: epidemiology and treatment. Curr Diab Rep. 2014;14:508. doi: 10.1007/s11892-014-0508-y. - DOI - PMC - PubMed
    1. Kidney Disease: Improving Global Outcomes KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–163. - PubMed
    1. Makris K, Spanou L. Acute kidney injury: definition, pathophysiology and clinical phenotypes. Clin Biochem Rev. 2016;37:85–98. - PMC - PubMed

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