ROLE OF HEMOGRAM AND IMMUNOGRAM PARAMETERS FOR PREDICTING THE COURSE OF ACUTE KIDNEY INJURY IN CHILDREN

AIM OF RESEARCH. To assess the role of hemogram and immunogram parameters for predicting the course of acute kidney injury (AKI) in children. PATIENTS AND METHODS. 272 children (boys/girls, 155/117, aged 35,3±2,6 months) were included in the study. 252 patients (92,65%) received conservative treatment and renal replacement therapy by intermittent hemodialysis (HD). The number of HD session averaged to 5,4±0 per 1 patient (1-21). 20 children (7,35%) received only conservative treatment. Proportion of patients with hemolytic-uremic syndrome amounted to 73,1%, those with glomerulonephritis – 6,2%, acute interstitial nephritis – 5,5%; other causes (acute intestinal infections, acute exogenous poisonings, abdominal surgical pathology, tumor lysis syndrome, meningococcal infection, etc.) made up 15,2%. Depending on the outcome of the disease, 2 groups of patients were formed: the 1st group included those who survived (65,5%), the 2nd group comprised those who died (34,5%). Morphologic structure of formed blood elements was investigated in all the examined children with the help of standard testing sets and automatic analyzers. Erythrocyte and leukocyte indices were determined, such as mean corpuscular volume (MCV), mean cell hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red deviation wide (RDW), mean platelet volume (MPV). Leukocyte reactivity indices were measured, such as nuclear shift and lymphocyte indices. The levels of immune complexes in blood serum and the amount of serum immunoglobulins A, G and M were determined. The data obtained in children from both the groups were compared depending on the AKI period: oligoanuria, initial diuresis, polyuria and clinical recovery, which corresponded to the 1st, 2nd, 3d and 4th weeks of the disease. RESULTS. Significant decrease in MCV (71,47±4,23 and 79,03±0,78, accordingly, р=0,0118057) and in lymphocyte index (0,52±0,02 and 0,71±0,03, accordingly, р=0,000002), as well as more pronounced leukocytosis (13,43±0,75 and 10,54±0,33·109 accordingly, р=0,000089) were observed in children of the 2nd group as compared with the 1st one. In all cases of the unfavorable ARF outcome, leukogram dynamics had no signs of the inflammatory process termination and was characterized by monocyto-, lymphocyto- and eosinopenia. CONCLUSION. Dynamic analysis of the hemogram findings with the determination of erythrocyte and leukocyte indices, as well as IgА, G and М levels allows predicting the ARF course and outcome. Prolonged microcytosis (more than 2 weeks), decreased lymphocyte index (less than 0,31) with no increase in dynamics, decreased IgA and IgG levels in blood serum by 50% and more from normal values are considered to be prognostically unfavorable factors of the ARF course and outcome.

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