Acute kidney injury following spinal instrumentation surgery in children

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 instru-mentation 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 identifed 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 fuids received intra-operatively classifed 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 fuid administered peri-operatively.