nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2017-3-54-60nefr-264Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSОСТРОЕ ПОВРЕЖДЕНИЕ ПОЧЕК У НОВОРОЖДЕННЫХ И ДЕТЕЙ ГРУДНОГО ВОЗРАСТА С ВРОЖДЕННЫМИ ПОРОКАМИ СЕРДЦА ПОСЛЕ КАРДИОХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВACUTE KIDNEY INJURY IN NEONATES AND INFANTS WITH CONGENITAL HEART DISORDERS AFTER CARDIAC SURGERYСеливерстоваА. А.SeliverstovaA. A.

аспирант кафедры факультетской педиатрии;

врач-кардиолог отделения анестезиологии и реанимации детей с кардиохирургической патологией клиники,

194100, Санкт-Петербург, ул. Литовская, д.2

MD, Cardiologist of the Department of Anesthesiology and Intensive Care of children with cardiac surgical pathology clinic;

Postgraduate, the Department of faculty Pediatric,

194100, St-Petersburg, Litovskaya str., 2 

alisa-0072006@yandex.ruСавенковаН. Д.SavenkovaN. D.

зав.каф. факультетской педиатрии, д.м.н., профессор, 

194100, Санкт-Петербург, ул. Литовская, д. 2

Prof., MD, PhD, DMedSci, Head of the Department of faculty pediatrics,

194100, St-Petersburg, Litovskaya str.,2

Savenkova.n.spb@mail.ruХубулаваГ. Г.HubulavaG. G.

Академик РАН, заведующий кафедрой сердечно-сосудистой хирургии, профессор, д.м.н.

194100, Санкт-Петербург, ул. Литовская, д. 2

Academician of RAS, MD, PhD, DMedSci, Head of the Department of Cardiovascular Surgery,

194100, St-Petersburg, Litovskaya str., 2

ggkh07@rambler.ruМарченкоС. П.MarchenkoS. P.

д.м.н., профессор кафедры сердечно-сосудистой хирургии,

194100, Санкт-Петербург, ул. Литовская, д. 2 

Prof., MD PhD, DMedSci, Department of Cardiovascular Surgery

194100, St-Petersburg, Litovskaya str.,2

sergeimarchenkospb@gmail.comНаумовА. Б.NaumovA. B.

заведующий отделением анестезиологии и реанимации детей с кардиохирургической патологией клиники,

194100, Санкт-Петербург, ул. Литовская, д. 2 

MD, Chief of the Department of Anesthesiology and Intensive Care of children with cardiac surgical pathology clinic,

194100, St-Petersburg, Litovskaya str., 2

naumov99@gmail.comСанкт-Петербургский государственный педиатрический медицинский университетРоссияSaint-Petersburg State Pediatric Medical UniversityRussian Federation2017250420172135460Copyright © Селиверстова А.А., Савенкова Н.Д., Хубулава Г.Г., Марченко С.П., Наумов А.Б., 20172017Селиверстова А.А., Савенкова Н.Д., Хубулава Г.Г., Марченко С.П., Наумов А.Б.Seliverstova A.A., Savenkova N.D., Hubulava G.G., Marchenko S.P., Naumov A.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/264ЦЕЛЬ

ЦЕЛЬ. Определить частоту, стратифицировать тяжесть кардиохирургически-ассоциированного острого повреждения почек (КХА-ОПП) по прогностической системе RACHS в 6 категориях риска у новорожденных и грудных детей с врожденными пороками сердца (ВПС).

ПАЦИЕНТЫ И МЕТОДЫ

ПАЦИЕНТЫ И МЕТОДЫ. В исследование включено 65 детей с ВПС до 1 года, из них 29(44,62%) новорожденных и 36(55,38%) от 1 месяца до 1 года, перенесших операцию. Диагноз ОПП установлен по AKIN-критериям (2007) с выделением 3-х стадий по уровню сывороточного креатинина (SCr). Тяжесть КХА-ОПП стратифицирована по прогностической системе RACHS в 6 категориях риска у новорожденных и грудных детей с ВПС.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Частота КХА-ОПП при ВПС у новорожденных в нашем исследовании составляет 72,1%, у грудных детей – 41,67%. Статистически значимых различий в частоте КХА-ОПП у новорожденных при операциях с использованием и без использования ИК (р>0,05) не выявлено. У детей старше месяца и до 1 года выявлены статистически значимые различия в частоте ОПП в зависимости от использования искусственного кровообращения (p<0,001). В зависимости от категорий риска по RACHS частота ОПП составила 25% во 2-й категории, 28,57% в 3-й категории, 78,95% в 4-й и 91,67% в 6-й категории. В 3 категории риска КХА-ОПП встречается чаще у новорожденных (45,45%) чем у детей грудного возраста (10%) (р=0,049). Статистически значимых различий в развитии ОПП у новорожденных и детей грудного возраста в 4 и 6 категориях риска по RACHS не выявлено (p>0,05). Высокая частота развития ОПП в 4-6 категориях установлена как у новорожденных, так и у детей грудного возраста.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Высокая частота развития КХА- ОПП у новорожденных и детей грудного возраста с ВПС требует мультидисциплинарного подхода к диагностике и лечению в отделениях кардиореанимации. Распределение пациентов по категориям RACHS позволяет прогнозировать риск развития и тяжесть КХА-ОПП у новорожденных и грудных детей. 

THE AIM

THE AIM. To determine frequency and severity of cardiac surgery-associated acute kidney injury (CSA-AKI) according to the predictive RACHS system of 6 risk categories in newborns and infants with CHD.

PATIENTS AND METHODS

PATIENTS AND METHODS. The study included 65 children under 1 year with CHD, 29 of them (44.62%) neonates and 36 newborns (55.38%) from 1 month to 1 year underwent surgery. The diagnosis of AKI was set up according to AKIN criteria (2007), with allocating 3 stages using the serum creatinine level (SCr). The severity of cardiac surgery associated AKI was distributed by categories of RACHS system of 6 risk categories in newborns and infants with CHD.

RESULTS

RESULTS. 72,1% of neonates and 41,67% of infants developed cardiac surgeryassociated AKI. Statistically significant differences in the incidence of AKI in newborns operated on with or without cardiopulmonary bypass were not revealed. In infants from 1 month to 1 year there were differences in AKI frequency with regard to using bypass for surgical correction (p<0,001). Depending on the RACHS risk category, AKI developed in 2nd category – 25%, 3rd category in 28.57%, 4th – 78,95% and 6th – 91.67%, respectively. In the 3rd risk category CSA-AKI was increased in neonates (45.45%) comparing to infants (10%) (p=0.049). Statistically significant differences in the development of AKI in neonates and infants in categories 4 and 6 RACHS were not found (p>0,05). The high incidence of AKI in 4-6 categories established both in neonates and infants.

CONCLUSION

CONCLUSION. The high incidence of CSA-AKI in neonates and infants requires a multidisciplinary approach for diagnosis and treatment in the cardiac ICU. The distribution of patients by RACHS categories allows to predict the risk and severity of CSA-AKI in newborns and infants. 

 

 

кардиохирургически-ассоциированное острое повреждение почекврожденные пороки сердцасистема RACHSCardiac surgery-associated acute kidney injurycongenital heart diseaseRACHSReferencesZappitelli M, Bernier PL, Saczkowski RS et al. A small postoperative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney Int 2009; 76:885–892Zappitelli M, Bernier PL, Saczkowski RS et al. A small postoperative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney Int 2009; 76:885–892Krawczeski CD, Vandevoorde RG, Kathman T et al. Serum cystatin C is an early predictive biomarker of acute kidney injury after pediatric cardiopulmonary bypass. Clin J Am SocNephrol 2010; 5:1552–1557Krawczeski CD, Vandevoorde RG, Kathman T et al. Serum cystatin C is an early predictive biomarker of acute kidney injury after pediatric cardiopulmonary bypass. Clin J Am SocNephrol 2010; 5:1552–1557Li S, Krawczeski CD, Zappitelli M et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery—a prospective multicenter study. Crit Care Med 2011; 39(6):1493–1499Li S, Krawczeski CD, Zappitelli M et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery—a prospective multicenter study. Crit Care Med 2011; 39(6):1493–1499Blinder JJ, Goldstein SL, Lee VV et al. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 2012;143:368–374Blinder JJ, Goldstein SL, Lee VV et al. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 2012;143:368–374Toth R, Breuer T, Cserep Z et al. Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery. Ann Thorac Surg 2012; 93:1984–1990Toth R, Breuer T, Cserep Z et al. Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery. Ann Thorac Surg 2012; 93:1984–1990Aydin SI, Seiden HS, Blaufox AD et al. Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg 2012; 94:1589–1595Aydin SI, Seiden HS, Blaufox AD et al. Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg 2012; 94:1589–1595Morgan CJ, Zappitelli M, Robertson CM et al. Western Canadian Complex Pediatric Therapies Follow-Up Group Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 2012; 162:120–127Morgan CJ, Zappitelli M, Robertson CM et al. Western Canadian Complex Pediatric Therapies Follow-Up Group Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 2012; 162:120–127Taylor ML, Carmona F, Thiagarajan RR et al. Mild postoperative acute kidney injury and outcomes after surgery for congenital heart disease. J Thorac Cardiovasc Surg 2013;146:146-152Taylor ML, Carmona F, Thiagarajan RR et al. Mild postoperative acute kidney injury and outcomes after surgery for congenital heart disease. J Thorac Cardiovasc Surg 2013;146:146-152AlAbbas A, Campbell A, Skippen P еt аl. Epidemiology of cardiac surgery-associated acute kidney injury in neonates: a retrospective study. Pediatr Nephrol 2013; (28): 1127-1134AlAbbas A, Campbell A, Skippen P еt аl. Epidemiology of cardiac surgery-associated acute kidney injury in neonates: a retrospective study. Pediatr Nephrol 2013; (28): 1127-1134Ricci Z, Di Nardo M, Iacoella C et al. Pediatric RIFLE for acute kidney injury diagnosis and prognosis for children undergoing cardiac surgery: a single-center prospective observational study. Pediatr Cardiol 2013;34:1404-1408Ricci Z, Di Nardo M, Iacoella C et al. Pediatric RIFLE for acute kidney injury diagnosis and prognosis for children undergoing cardiac surgery: a single-center prospective observational study. Pediatr Cardiol 2013;34:1404-1408Gil-Ruiz Gil-Esparza MA, Alcaraz Romero AJ, Romero Otero A et al. Prognostic relevance of early AKI according to pRIFLE criteria in children undergoing cardiac surgery. Pediatr Nephrol 2014; 29:1265-1272Gil-Ruiz Gil-Esparza MA, Alcaraz Romero AJ, Romero Otero A et al. Prognostic relevance of early AKI according to pRIFLE criteria in children undergoing cardiac surgery. Pediatr Nephrol 2014; 29:1265-1272Joan Sanchez-de-Toledo, Alba Perez-Ortiz, Laura Gil et al. Abella Early Initiation of Renal Replacement Therapy in Pediatric Heart Surgery Is Associated with Lower Mortality. Pediatr Cardiol 2016; 37(4):623-628Joan Sanchez-de-Toledo, Alba Perez-Ortiz, Laura Gil et al. Abella Early Initiation of Renal Replacement Therapy in Pediatric Heart Surgery Is Associated with Lower Mortality. Pediatr Cardiol 2016; 37(4):623-628Kurt D. Piggott, Meshal Soni, William M. Decampli et al. Pourmoghadam Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease. World Journal for Pediatric and Congenital Heart Surgery 2015; 6(3): 401-406Kurt D. Piggott, Meshal Soni, William M. Decampli et al. Pourmoghadam Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease. World Journal for Pediatric and Congenital Heart Surgery 2015; 6(3): 401-406Kwiatkowski D.M. and Krawczeski C.D. Acute Kidney Injury after cardiovascular surgery in children. In Perioperative Kidney Injury: Principles of Risk Assessment, Diagnosis and Treatment. Editors C.V.Thakar, C.V. Parikh, Springer 2015; 99-109Kwiatkowski D.M. and Krawczeski C.D. Acute Kidney Injury after cardiovascular surgery in children. In Perioperative Kidney Injury: Principles of Risk Assessment, Diagnosis and Treatment. Editors C.V.Thakar, C.V. Parikh, Springer 2015; 99-109D. Klauwer, C. Neuhäuser, J. Thul, R. Zimmermann. Pädiatrische Intensivmedizin – Kinderkardiologische Praxis. Copyright by Deutscher Ärzte-Verlag GmbH 2013; 93-125D. Klauwer, C. Neuhäuser, J. Thul, R. Zimmermann. Pädiatrische Intensivmedizin – Kinderkardiologische Praxis. Copyright by Deutscher Ärzte-Verlag GmbH 2013; 93-125Селиверстова АА, Савенкова НД, Марченко СП, Наумов АБ. Кардиохирургически-ассоциированное острое повреждение почек у детей. Нефрология 2016; 20 (3): 17-27 [SeliverstovaAA, Savenkova ND, Marchenko SP, Naumov AB Kardiohirurgicheski-associirovannoe ostroe povregdenie pochek y detej. Nephrologija 2016; 20 (3); 17-27]Селиверстова АА, Савенкова НД, Марченко СП, Наумов АБ. Кардиохирургически-ассоциированное острое повреждение почек у детей. Нефрология 2016; 20 (3): 17-27 [SeliverstovaAA, Savenkova ND, Marchenko SP, Naumov AB Kardiohirurgicheski-associirovannoe ostroe povregdenie pochek y detej. Nephrologija 2016; 20 (3); 17-27]Mehta RL, Kellum JA, Shah SV et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11(2):R31Mehta RL, Kellum JA, Shah SV et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11(2):R31Jenkins KJ, Gauvreau K, Newburger JW et al. Consensusbased method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002;123(1):110–118Jenkins KJ, Gauvreau K, Newburger JW et al. Consensusbased method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002;123(1):110–118Jenkins KJ, Gauvreau K. Center-specific differences in mortality: preliminary analyses using the risk adjustment in congenital heart surgery (RACHS-1) method. J Thorac Cardiovasc Surg 2002; 124(1):97–104Jenkins KJ, Gauvreau K. Center-specific differences in mortality: preliminary analyses using the risk adjustment in congenital heart surgery (RACHS-1) method. J Thorac Cardiovasc Surg 2002; 124(1):97–104J. H. Wong, D. T. Selewski, S. Yu et al. DeWitt Severe Acute Kidney Injury Following Stage 1 Norwood Palliation: Effect on Outcomes and Risk of Severe Acute Kidney Injury at Subsequent Surgical Stages. Pediatric Critical Care Medicine 2016; 20(30): 1-9J. H. Wong, D. T. Selewski, S. Yu et al. DeWitt Severe Acute Kidney Injury Following Stage 1 Norwood Palliation: Effect on Outcomes and Risk of Severe Acute Kidney Injury at Subsequent Surgical Stages. Pediatric Critical Care Medicine 2016; 20(30): 1-9

The authors declare that there are no conflicts of interest present.