Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Mar 6, 2017; 6(2): 79-85
Published online Mar 6, 2017. doi: 10.5527/wjn.v6.i2.79
Acute kidney injury following spinal instrumentation surgery in children
Jasper J Jöbsis, Abdullah Alabbas, Ruth Milner, Christopher Reilly, Kishore Mulpuri, Cherry Mammen
Jasper J Jöbsis, Department of Paediatrics, Tergooi Hospital, 1261 AN Blaricum, The Netherlands
Abdullah Alabbas, Stollery Children’s Hospital, Edmonton, AB T6G 2L9, Canada
Ruth Milner, Christopher Reilly, Kishore Mulpuri, Cherry Mammen, BC Children’s Hospital, Vancouver, BC V6H 3V4, Canada
Author contributions: Jöbsis JJ and Allabas A contributed equally in data collection and drafting the manuscript; Mammen C designed and supervised the study; Reilly C and Mulpuri K revised the manuscript for important intellectual content; Milner R offered statistical support; all authors have read and approved the final version to be published.
Institutional review board statement: This study is retrospective, involving anonymous clinical data without affecting the patient’s rights and welfare. The study was reviewed and approved by the BC Children’s Hospital/University of British Columbia Institutional Review Board.
Informed consent statement: As per the BC Children’s Hospital Institutional Review Board, informed consent was not required for this retrospective study. Subjects are not identifiable from any data presented in this manuscript.
Conflict-of-interest statement: None of the authors have any conflicts of interest related to this research topic.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at jjobsis@tergooi.nl. Informed consent was not obtained, but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jasper J Jöbsis, MD, Department of Paediatrics, Tergooi Hospital, Rijksstraatweg 1, 1261 AN Blaricum, The Netherlands. jjobsis@tergooi.nl
Telephone: +31-88-7531753 Fax: +31-88-7531168
Received: June 5, 2016
Peer-review started: June 9, 2016
First decision: July 5, 2016
Revised: December 23, 2016
Accepted: January 11, 2017
Article in press: January 14, 2017
Published online: March 6, 2017
Abstract
AIM

To determine acute kidney in jury (AKI) incidence and potential risk factors of AKI in children undergoing spinal instrumentation surgery.

METHODS

AKI incidence in children undergoing spinal instrumentation surgery at British Columbia Children’s Hospital between January 2006 and December 2008 was determined by the Acute Kidney Injury Networ classification using serum creatinine and urine output criteria. During this specific time period, all patients following spinal surgery were monitored in the pediatric intensive care unit and had an indwelling Foley catheter permitting hourly urine output recording. Cases of AKI were identified from our database. From the remaining cohort, we selected group-matched controls that did not satisfy criteria for AKI. The controls were matched for sex, age and underlying diagnosis (idiopathic vs non-idiopathic scoliosis).

RESULTS

Thirty five of 208 patients met criteria for AKI with an incidence of 17% (95%CI: 12%-23%). Of all children who developed AKI, 17 (49%) developed mild AKI (AKI Stage 1), 17 (49%) developed moderate AKI (Stage 2) and 1 patient (3%) met criteria for severe AKI (Stage 3). An inverse relationship was observed with AKI incidence and the amount of fluids received intra-operatively. An inverse relationship was observed with AKI incidence and the amount of fluids received intra-operatively classified by fluid tertiles: 70% incidence in those that received the least amount of fluids vs 29% that received the most fluids (> 7.9, P = 0.02). Patients who developed AKI were more frequently exposed to nephrotoxins (non steroidal anti inflammatory drugs or aminoglycosides) than control patients during their peri-operative course (60% vs 22%, P < 0.001).

CONCLUSION

We observed a high incidence of AKI following spinal instrumentation surgery in children that is potentially related to the frequent use of nephrotoxins and the amount of fluid administered peri-operatively.

Keywords: Acute kidney injury, Epidemiology, Acute Kidney Injury Network, Spinal surgery, Children

Core tip: We are the first to report a high incidence of acute kidney injury (AKI) of 17% in children undergoing orthopaedic spinal instrumentation surgery utilizing the Acute Kidney Injury Network definition. A relationship was observed between the development of AKI and the use of nephrotoxins including non-steroidal anti-inflammatory drugs and lower amounts of intravenous fluid administered peri-operatively. These results suggest that there are modifiable AKI risk factors with the potential of reducing AKI incidence in this understudied population. Further prospective studies with the use of novel AKI biomarkers are needed to validate our novel results.