Author Of 1 Presentation
HISTOPATHOLOGICAL CHANGES IN SEPTIC ACUTE KIDNEY INJURY IN CRITICALLY ILL CHILDREN-PROSPECTIVE OBSERVATION STUDY ON POSTMORTEM RENAL BIOPSIES.
Abstract
Background
More than half of all cases of AKI in critically ill children are sepsis or sepsis-related. Understanding of the renal histopathological changes will give a better insight into the pathogenesis of pediatric septic AKI. No prospective study of the histopathological features of septic AKI in critically ill children has been performed.
Objectives
To study the histopathological changes in septic AKI.
Methods
A prospective observational study involving children aged less than 12-year died with septic AKI screened for percutaneous renal biopsy from January-2015 to February-2019. Three core of kidney tissue were taken for histopathological evaluation by light and immunofluorescence examination. Sepsis and AKI were defined using international pediatric sepsis consensus conference and AKIN criteria respectively.
Results
A total of 2249 patients were admitted to the PICU with a mortality of 25 % (n = 562) and 39 complete data of post-mortem renal histopathological reports were included. The median (IQR) age was 22.5 (5–75) months and PRISM-III was 17 (13–23). Normal histology was the most common change 46% (n=18) followed by acute tubular necrosis (ATN) 33% (n=13). A combination of changes involving tubules, glomeruli, interstitium, and blood vessels was noted in 23% (n=9) of the specimens. Three percentage (n=1) of the specimens had features consistent with thrombotic microangiopathy. Normal histology was noted in 11% (n = 2/18), 72.2 % (n = 13/18), and 16.7 % (n = 3/18) of AKI stage I, II, and III respectively.
Conclusion
The most common renal histopathological change in septic AKI in critically ill children was normal histology followed by ATN.