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CLASSIFICATION OF ACUTE KIDNEY INJURY USING THE p-RIFLE IN A PEDIATRIC INTENSIVE CARE
UNIT IN CALI, COLOMBIA
Gaston Castillo, Jaime Restrepo, Angie Rods, Duke Maria Del Pilar, Fernando Bermudez, Magda Cepeda, Oscar Ramírez
Fundación Valle del Lili, Cali, Colombia.
OBJECTIVE:
To use the p-RIFLE classification for estimate the incidence of AKI in children in a Pediatric Intensive Care Unit (PICU) and
describe their clinical characteristics.
MATERIALS AND METHODS
Between September/2009 to December/2011, p-RIFLE classification was applied prospectively to assess renal injury in children
hospitalized in the PICU of the FVL. Of the patients with ARF are described: causes, scale PRISM, mortality, and renal
replacement therapy (RRT) used.
RESULTS
Of 2100 patients admitted to PICU, 98 patients classified with AKI, accounting for an incidence of 4.7%. Median age was 2
years (IQR = 0.17 to 9 years), 54.64% male (table 1).
Table 1. General characteristics
Age (years)*
2 (0.17-9)
Sex (M) (n[%])
53 (54.64)
Height (cm)*
88 (57-122)
Weight (kg)*
10 (4.5-25)
PRISM*
25 (15.75-37.5)
*Median (Interquartilic range)
Half of the patients had 10 or fewer kg (IQR = 4.5-25 kg). The distribution of renal injury according to p-RIFLE classification
was risk (R) 14.3% and 39.8%, injury (I) 26.5% and 13.2%, failure (F) 58.1% and 44.9% and loss (L) 1.02% and 2.04%, at 24
and 72 hours of admission, respectively (Figure 1).
The main causes were postoperative cardiovascular surgery in 31.9%, 14.43% and sepsis in solid organ transplant in 10.31%,
malignance at 8.25%, 8.25% kidney, lung, 8.25%, 6.2% liver and bone marrow transplantation in 5.2%. In this population, the
need for RRT was 51%. Mortality was 43.81%, and mortality at 24 hours was higher in patients at risk, while at 72 hours was
higher in failure.
DISCUSSION: The incidence of AKI (4.7%) was higher than that observed previously in the same institution (2.1% between
1996 and 2006). By using the P-RIFLE classification for AKI, it was possible to identify patients earlier, when they are at risk,
and it could be related to the lowering in mortality (53.6% (1996-2006) vs 43.81% (2009-2011)). The postoperative
cardiovascular patients and sepsis remain the main causes of AKI. These results allows to recommend the use of protocols that
use the P-RIFLE as a strategy for identifying patients for early detection of renal injury and stop the progression of the AKI,
decreasing mortality.
CONCLUSSION
Use p-RIFLE score allows to detect earlier patients with AKI. Sepsis and cardiovascular surgery remain leading causes of AKI
and mortality. Prospective protocols introducing p-RIFLE classification are needed to point out the risk factors of AKI in
children.
Fundación Valle del Líli, Cra. 98 # 18-49, Phone Number: (57) 3113218282 e-mail: gastonemd@hotmail.es