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Furosemide stress test to predict acute kidney injury progression in critically ill children.

Furosemide stress test to predict acute kidney injury progression in critically ill children.

Authors :
Krishnasamy, Sudarsan
Sinha, Aditi
Lodha, Rakesh
Sankar, Jhuma
Tarik, Mohamad
Ramakrishnan, Lakshmy
Bagga, Arvind
Hari, Pankaj
Source :
Pediatric Nephrology. Jan2025, Vol. 40 Issue 1, p243-251. 9p.
Publication Year :
2025

Abstract

Background: Furosemide stress test (FST) is a novel functional biomarker for predicting severe acute kidney injury (AKI); however, pediatric studies are limited. Methods: Children 3 months to 18 years of age admitted to the intensive care unit (ICU) of a tertiary care hospital from Nov 2019 to July 2021 were screened and those who developed AKI stage 1 or 2 within 7 days of admission underwent FST (intravenous furosemide 1 mg/kg). Urine output was measured hourly for the next 6 h; a value > 2 ml/kg within the first 2 h was deemed furosemide responsive. Other biomarkers like plasma neutrophil gelatinase-associated lipocalin (NGAL) and proenkephalin (PENK) were also evaluated. Results: Of the 480 admitted patients, 51 developed AKI stage 1 or 2 within 7 days of admission and underwent FST. Nine of these patients were furosemide non-responsive. Thirteen (25.5%) patients (eight of nine from FST non-responsive group) developed stage 3 AKI within 7 days of FST, nine (17.6%) of whom (seven from non-responsive group) required kidney support therapy (KST). FST emerged as a good biomarker for predicting stage 3 AKI and need for KST with area-under-the-curve (AUC) being 0.93 ± 0.05 (95% CI 0.84–1.0) and 0.96 ± 0.03 (95% CI 0.9–1.0), respectively. FST outperformed NGAL and PENK in predicting AKI stage 3 and KST; however, the combination did not improve the diagnostic accuracy. Conclusions: Furosemide stress test is a simple, inexpensive, and robust biomarker for predicting stage 3 AKI and KST need in critically ill children. Further research is required to identify the best FST cut-off in children. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
0931041X
Volume :
40
Issue :
1
Database :
Academic Search Index
Journal :
Pediatric Nephrology
Publication Type :
Academic Journal
Accession number :
181065958
Full Text :
https://doi.org/10.1007/s00467-024-06387-5