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  • Title: Prediction of Severe Acute Kidney Injury using Renal Angina Index in a Pediatric Intensive Care Unit.
    Author: Gawadia J, Mishra K, Kumar M, Saikia D.
    Journal: Indian Pediatr; 2019 Aug 15; 56(8):647-652. PubMed ID: 31477644.
    Abstract:
    OBJECTIVE: To determine the proportion of children in a pediatric intensive care unit with a positive Day 0 Renal angina index who develop severe acute kidney injury (AKI) on Day 3; and to compare the predictive ability of the index with that of individual markers of renal injury, for the development of severe acute kidney injury. DESIGN: Observational study. SETTING: Pediatric intensive care unit of a tertiary-care hospital. PARTICIPANTS: Consecutive children, 1 month to 12 years, admitted in Level 3 pediatric intensive care unit for a minimum of 8 hours, having weight and intake-output records, were eligible. Children known to have chronic kidney disease or already in stage 2/3 acute kidney injury/dialysis were excluded. PROCEDURE: Day 0 Renal angina index was calculated from the product of Risk Group score (Pediatric intensive care admission/Ventilation and inotropy) and Renal Injury score (fluid overload over previous 8 hours or the % fall in estimated creatinine clearance from baseline). Renal angina index ³8 was considered positive. MAIN OUTCOME MEASURE: The proportion of children with positive Day 0 Renal angina index who develop severe AKI (Kidney Disease Improving Global Outcomes (KDIGO) ≥ Stage 2) on Day 3. RESULTS: Of 162 enrolled children (median (IQR) age 10.5 (3,39) months), 86 (53%) had positive Renal angina index. On Day 3, a higher proportion of children with positive index developed severe AKI, compared to negative group (RR 95.5; 95% CI 21.7,420.5; P<0.001). Day 0 positive Renal angina index had a sensitivity, specificity, positive predictive value and negative predictive value of 96.9%, 75.5%, 72% and 97.4% respectively, for predicting severe AKI on Day 3. The Receiver Operating Characteristic curve of Day 0 renal angina scores showed AUC of 0.90 (95% CI 0.85, 0.95), better than the AUC obtained from either Day 0 serum creatinine or Day 0 percent fall in estimated creatinine clearance from baseline. CONCLUSIONS: Day 0 Renal angina index positivity is a promising tool to identify critically ill children with impending severe AKI.
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