ESPN 50th Annual Meeting

ESPN 2017


 
SEVERE ACUTE KIDNEY INJURY (AKI) AND RENAL REPLACEMENT THERAPY (RRT) IN CHILDREN WITH ACUTE MENINGOCOCCEMIA: FINDINGS FROM A LARGE COHORT
KAROLIS AZUKAITIS 1 RENATA VITKEVIC 2 VILMANTA BUROKIENE 2 AUGUSTINA JANKAUSKIENE 1

1- CLINIC OF PEDIATRICS, FACULTY OF MEDICINE, VILNIUS UNIVERSITY, VILNIUS, LITHUANIA
2- CHILDREN HOSPITAL, AFFILIATE OF VILNIUS UNIVERSITY HOSPITAL SANTARISKIU CLINICS, VILNIUS, LITHUANIA
 
Introduction:

 Compared to other septic conditions, acute meningococcemia is associated with fulminant disease course and high mortality rates. The scarce data about AKI in this population could be explained by increasing immunization and high mortality rates. Lithuania is an endemic zone for serogroup B meningococcal infections and immunization has not been implemented nationwide yet. We aimed to analyze the prevalence and early renal outcomes of children with acute meningococcemia and severe AKI requiring RRT.

Material and methods:

 A retrospective chart review for the period of January 2009-March 2017 was performed to identify children with laboratory confirmed meningococcal septicaemia treated in our institution.

Results:

 A total of 161 patients (49.7% boys) with acute meningococcemia were identified. Median age at diagnosis was 2.5 years (range 1 month-17 years). Sixteen patients (9.9%) with fulminant disease course died, typically within the first 24 hours since admission. RRT was initiated in four (2.5%) patients (details in Table 1).

Table 1.

 

Age (y)

Sex

Complications

Time to oliguria (h)

Time to RRT (h)

Time on RRT (days)

RRT employed (duration in days)

Length of stay (days)

Renal function on discharge

GFR (ml/min/1.73 m2)

Urinalysis

Hypertension

1.7

M

Septic shock. Acute heart failure. DIC

30

40

10

CCPD (10)

24

>90

N

No

2

M

Septic shock. Acute heart failure. DIC

16

27

12

CCPD (3) -> CVVHDF (3) -> CCPD (6)

33

80

Protein+

Hematuria+

Yes

9

M

Septic shock

10

33

16

CCPD (7) -> CVVHDF (5) -> HD (4)

28

55

N

Yes

1.3

M

Septic shock. Multiorganic failure. DIC

14

46

16

CVVHDF (CARPEDIEM) (2) -> CCPD (14)

47

>90

N

Yes

Conclusions:

 The prevalence of severe AKI necessitating RRT in our cohort of children with acute meningococcemia was low (2.5%). RRT was typically initiated on day two after disease onset and continued for 10-16 days.