ESPN 50th Annual Meeting

ESPN 2017


 
Acute kidney injury in children after cardiac catheterisation
MARCIN TKACZYK 1 DARIA TOMCZYK 1 ANNA JANDER 1 TOMASZ MOSZURA 2 PAWEł DRYZEK 2 EWA GłOWACKA 3 Wojciech Krajewski 1 SEBASTIAN GORECZNY 2

1- DEPARTMENT OF PEDIATRICS, IMMUNOLOGY AND NEPHROLOGY, POLISH MOTHERS MEMORIAL HOSPITAL RESEACH INSTITUTE
2- DEPARTMENT OF CARDIOLOGY, POLISH MOTHERS MEMORIAL HOSPITAL RESEACH INSTITUTE
3- CENTRE OF MEDICAL DIAGNOSTICS. POLISH MOTHERS MEMORIAL HOSPITAL RESEACH INSTITUTE
 
Introduction:

Acute kidney injury (AKI)  often occurs in the course of invasive cardiac surgery procedures in children.   Invasive cardiology procesures with contrast media administration also might have a negative influence on patients kidney function. The ouf our study was to establish the incidence and recovery rate of AKI after cardiac catheterisation in children with complicated cardiac malformations.

Material and methods:

The study was a prospective observational project amongst children with complicated cardiac malformation, who were qualified for diagnostic cardiac catheterisation before cardiac surgery. The study group consisted initially of 72 children aged (0-18y). 18 children were excluded because of consent withdrawal. Finally, 50 children (35M:15F) were analysed. They uderwent standard clinical procedure of cardiac catherisation (11 for diagnostics and 39 for combined diagnostics and intervention). 32 patients had at least on catheterizations before. 11 children had AKI during previous cardiac surgery procedures. 26 children required chronic diuretic treatment. Patients with preexisting chronic kidney injury or malfomations were excluded. pRIFLE score was applied initially for AKI assessment. Data  were gathered before procedure and after 2,6,24 and 48 hours. Additionally, serum neutrophil gelatinase (NGAL) concentration was assessed (ELISA). The study was approved by the local EC and all caregivers gave an informed consent. The study was granted by Polish Mothers Memorial Hospital Reserach Institute - internal grant 2014/IV/42-GW

Results:

AKI by pRIFLE criteria was detected in 22 patients (44% - R-17/I-5). It occurred within 24 hours of observation in 16 patients, whereas in 6 subjects later between 25-48 hours post contrast administration. We observed a significant (p<0.05) rise in NGAL concentration in serum after 2 and 6 hours (41, and 46 ng/ml) with subsequent decrease within 24 hours to 32 ng/ml . Cystatin C rose significantly (p<0.05) after 24 hours (816±1139 ng/ml) with decrease after 48 hours. Follow-up analysis showed normal renal function in all children.  Only 2/16 AKI children had decreased urine output. No significant decrease in cardiac function was noted, however NT-proBNP concentration was elevated before procedure 836±1 369 pg/ml. 

Conclusions:

We showed that post-contrast AKI had high incidence in children with complicated cardiac malformations after cardiac catherisation. Urine output criteria proved little value because of routine diuretic administration in this selected group of patients.