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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2017  |  Volume : 28  |  Issue : 2  |  Page : 435-436
The cutoff 1st day urine specific gravity in critically ill children: Predictive factor for early abnormal glomerular filtration rate


Department of Nephrology, Sevom-e-Shaban Hospital, Tehran, Iran

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Date of Web Publication23-Mar-2017
 

How to cite this article:
Malaki M. The cutoff 1st day urine specific gravity in critically ill children: Predictive factor for early abnormal glomerular filtration rate. Saudi J Kidney Dis Transpl 2017;28:435-6

How to cite this URL:
Malaki M. The cutoff 1st day urine specific gravity in critically ill children: Predictive factor for early abnormal glomerular filtration rate. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2019 Jun 27];28:435-6. Available from: http://www.sjkdt.org/text.asp?2017/28/2/435/202782
To the Editor,

Acute kidney injury (AKI) represents a broad spectrum of clinical presentation with a wide range of prevalence rates from 1% to 70% in Intensive Care Unit (ICU) patients and is associated with high mortality rate.[1],[2] In spite of the availability of plenty of information about the incidence and prognosis of AKI in ICU patients, there are few epidemiological studies about risk assessment for AKI susceptibility and risk factors for the development of chronic kidney disease.[3] It is obvious that risk factor assessment for AKI can be a difficult matter because the primary diseases for ICU admission can be varied, for example, this risk is higher in surgical cases in compared to medical cases.[4] In this study, we attempted to evaluate the benefit of assessing the 1st day urine specific gravity (USG) on the development of AKI on the 5th day, in critically ill children who are admitted to the pediatric ICU. We followed up 37 children aged over two years who were admitted because of an acute medical illness. Their glomerular filtration rate (GFR) was measured by the Schwartz method and values under 75 mL/min/1.73 m2 were considered abnormal.[5] The patients’ USG on the 1st day of admission was recorded by traditional urine tape test and values of over 1018, 1020, 1022, 1024, and 1026 were noted. On the other hand, GFR was measured on the 5th day and value lower than 75 was considered abnormal. The relationship was assessed by studying USG in these groups by Chi-square test, and our results showed that USG on the 1st day of admission above 1024 was associated with abnormal GFR [Table 1]. Abnormal GFR on the 5th day was seen in 57% of cases, in whom the admission USG was above 1026, 50% if USG was above 1024, 41% if USG was above 1022, 33% if USG was above 1020, and 21% if USG was above 1018. The likelihood ratio for developing abnormal GFR was five times if the USG was above 1024 (P = 0.03) and 4.9 if USG was above 1026 (P =0.03).
Table 1: Relationship between 1st day urine specific gravity and glomerular filtration rate.

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There are several factors known to increase the risk of developing AKI that was assessed by de Mendonça et al in patients admitted to the ICU. Their study was performed on adults, and they estimated the incidence of AKI, defined by serum creatinine higher than 3.5 mg/dL with oliguria, to be 24% (urine output less 500 mL/day). They found that patients with AKI were more frequently associated with multiple organ failure compared to the non-AKI group.[6] Other studies in critically ill adult groups showed that many factors can share the increased risk of AKI such as patient’s associated diseases, hemodynamic condition, and age.[7] In this study, renal function impairment was assessed in critically ill children with medical illness without considering other factors, just based on arrival USG. The results showed that increased USG correlates positively with the risk of developing renal failure.

Abnormal GFR is a concealed risk factor for critically ill children and 1st day USG is a cheap and accessible test, can give a caution the physicians about the risk of developing AKI. In this study, the cutoff measure for USG was 1024 or higher.


   Acknowledgment Top


I dedicate this study to my unique leader Dr. Mohammad Mosadegh.

Conflicting Interest:

None declared.

 
   References Top

1.
Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 1998;104:343-8.  Back to cited text no. 1
    
2.
Escoresca Ortega AM, Ruíz de Azúa López Z, Hinojosa Pérez R, et al. Kidney failure after heart transplantation. Transplant Proc 2010;42: 3193-5.  Back to cited text no. 2
    
3.
Hoste EA, Kellum JA. Acute kidney injury: Epidemiology and diagnostic criteria. Curr Opin Crit Care 2006;12:531-7.  Back to cited text no. 3
    
4.
Singbartl K, Kellum JA. AKI in the ICU: Definition, epidemiology, risk stratification, and outcomes. Kidney Int 2012;81:819-25.  Back to cited text no. 4
    
5.
Pottel H, Hoste L, Delanaye P. Abnormal glomerular filtration rate in children, adolescents and young adults starts below 75 mL/min/1.73 m2. J Int Pediatr Nephrol Assoc 2015;30:821-8.  Back to cited text no. 5
    
6.
de Mendonça A, Vincent JL, Suter PM, et al. Acute renal failure in the ICU: Risk factors and outcome evaluated by the SOFA score. Intensive Care Med 2000;26:915-21.  Back to cited text no. 6
    
7.
Chawla LS, Abell L, Mazhari R, et al. Identifying critically ill patients at high risk for developing acute renal failure: A pilot study. Kidney Int 2005;68:2274-80.  Back to cited text no. 7
    

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Correspondence Address:
Dr. Majid Malaki
Department of Nephrology, Sevom-e-Shaban Hospital, Tehran
Iran
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DOI: 10.4103/1319-2442.202782

PMID: 28352036

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