• Michelle N Rheault, Lei Zhang, David T Selewski, Mahmoud Kallash, Cheryl L Tran, Meredith Seamon, Chryso Katsoufis, Isa Ashoor, Joel Hernandez, Katarina Supe-Markovina, Cynthia D'Alessandri-Silva, Nilka DeJesus-Gonzalez, Tetyana L Vasylyeva, Cassandra Formeck, Christopher Woll, Rasheed Gbadegesin, Pavel Geier, Prasad Devarajan, Shannon L Carpenter, Bryce A Kerlin, William E Smoyer, and Midwest Pediatric Nephrology Consortium.
• Due to the number of contributing authors, the affiliations are provided in the Supplemental Material. rheau002@umn.edu.
• Clin J Am Soc Nephrol. 2015 Dec 7; 10 (12): 2110-8.

Background And ObjectivesChildren with nephrotic syndrome can develop life-threatening complications, including infection and thrombosis. While AKI is associated with adverse outcomes in hospitalized children, little is known about the epidemiology of AKI in children with nephrotic syndrome. The main objectives of this study were to determine the incidence, epidemiology, and hospital outcomes associated with AKI in a modern cohort of children hospitalized with nephrotic syndrome.Design, Setting, Participants, & MeasurementsRecords of children with nephrotic syndrome admitted to 17 pediatric nephrology centers across North America from 2010 to 2012 were reviewed. AKI was classified using the pediatric RIFLE definition.ResultsAKI occurred in 58.6% of 336 children and 50.9% of 615 hospitalizations (27.3% in stage R, 17.2% in stage I, and 6.3% in stage F). After adjustment for race, sex, age at admission, and clinical diagnosis, infection (odds ratio, 2.24; 95% confidence interval, 1.37 to 3.65; P=0.001), nephrotoxic medication exposure (odds ratio, 1.35; 95% confidence interval, 1.11 to 1.64; P=0.002), days of nephrotoxic medication exposure (odds ratio, 1.10; 95% confidence interval, 1.05 to 1.15; P<0.001), and intensity of medication exposure (odds ratio, 1.34; 95% confidence interval, 1.09 to 1.65; P=0.01) remained significantly associated with AKI in children with nephrotic syndrome. Nephrotoxic medication exposure was common in this population, and each additional nephrotoxic medication received during a hospitalization was associated with 38% higher risk of AKI. AKI was associated with longer hospital stay after adjustment for race, sex, age at admission, clinical diagnosis, and infection (difference, 0.45 [log]days; 95% confidence interval, 0.36 to 0.53 [log]days; P<0.001).ConclusionsAKI is common in children hospitalized with nephrotic syndrome and should be deemed the third major complication of nephrotic syndrome in children in addition to infection and venous thromboembolism. Risk factors for AKI include steroid-resistant nephrotic syndrome, infection, and nephrotoxic medication exposure. Children with AKI have longer hospital lengths of stay and increased need for intensive care unit admission.Copyright © 2015 by the American Society of Nephrology.

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