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Aurel Bizo

Latest posts by Aurel Bizo (see all)

  • NEFROPATIILE TOXICE IN INTOXICATIILE ACUTE LA COPIL SI ADOLESCENT – PREVALENTA, CAUZE SI FACTORI DE RISC - 21/07/2015
  • ACUTE KIDNEY INJURY IN CHILDREN AND ADOLESCENT POISONING – PREVALENCE, ETIOLOGY AND RISK FACTORS - 21/07/2015

Articole semnate de acelasi autor in Revista Romana de Pediatrie:

NEFROPATIILE TOXICE IN INTOXICATIILE ACUTE LA COPIL SI ADOLESCENT – PREVALENTA, CAUZE SI FACTORI DE RISC

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 1, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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NEFROPATIILE TOXICE IN INTOXICATIILE ACUTE LA COPIL SI ADOLESCENT – PREVALENTA, CAUZE SI FACTORI DE RISC

Alexandru-Ioan Ulmeanu, Aurel Bizo and Coriolan Ulmeanu

REZUMAT

Obiective. Incidenţa şi prevalenţa reală a afectării renale în cadrul intoxicaţiilor copilului nu este pe deplin cunoscută, modificările funcţionale şi structurale renale cauzate de nefrotoxine sunt nespecifice şi de multe ori etiologia toxică este trecută în plan secund. Studiul de faţă îşi propune evaluarea prevalenţei nefropatiilor toxice la copii spitalizaţi pentru intoxicaţii acute, etiologia, aspectele clinice şi paraclinice, factorii de prognostic pozitiv sau negativ, frecvenţa folosirii tehnicilor de epurare extrarenală şi impactul acestora asupra supravieţuirii.

Material şi metodă. Am realizat un studiu observaţional, retrospectiv, bicentric pe o perioadă de 10 ani, pe un lot ce a cuprins 82 de pacienţi între 0-18 ani din două centre antitoxice pediatrice: în cadrul secţiei de Toxicologie a SCUC „Grigore Alexandrescu“, Bucureşti şi în cadrul secţiei de Nefrologie şi Toxicologie Pediatrică din cadrul Spitalului Clinic de Urgenţă de Copii din Cluj-Napoca. În lotul de studiu au fost incluşi pacienţi cu intoxicaţie acută ce au prezentat în evoluţie injurie renală acută definită după criteriile AKIN.

Rezultate. Prevalenţa injuriei renale acute toxice a fost de 1%. Etiologia acesteia este dominată de medicamente – 36,6% urmate de ciuperci – 24,4%, insecticide – 18,3% şi alcooli cu 11%. În procente mult mai mici au fost implicate substanţele caustice, hidrocarburile, substanţele methemoglobinizante şi plumbul. În grupul intoxicaţiilor medicamentoase au predominat intoxicaţiile plurimedicamentoase, urmate de intoxicaţiile cu antibiotice, cel mai frecvent fiind implicată gentamicina. În cazul intoxicaţiilor plurimedicamentoase substanţele cel mai frecvent implicate au fost: combinaţii de AINS cu Paracetamol şi Metamizol. În cadrul intoxicaţiilor cu ciuperci în majoritatea cazurilor au fost implicate ciupercile cu durată de incubaţie lungă, cel mai probabil Amanita Phalloides. Etiologia intoxicaţiilor cu alcooli a cuprins cel mai frecvent etilenglicolul. În intoxicaţiile cu insecticide etiologia a fost reprezentată mai ales de către insecticidele organofosforice şi carbamate. Pe lotul studiat de 82 de cazuri, s-au înregistrat 26 de decese, mortalitatea a fost de 32%. Au reprezentat factori de risc pentru deces următorii: oliguria, anuria, edemele, manifestările hemoragice, polipneea, semnele de şoc, coma, hepatocitoliza şi insuficienţa hepatică. Metodele de epurare extrarenală sau substituţie renală au fost aplicate în 41% din cazuri. Ele nu au reprezentat factori de protecţie pe lotul studiat.

Concluzii. Intoxicaţiile acute la copil înregistrează o creştere importantă în ultimii ani în toată ţara. Cazurile cu injurie renală acută toxică au un prognostic de multe ori rezervat, astfel că acestea, precum şi factorii de risc asociaţi trebuie identificate şi diagnosticate rapid în vederea instituirii unui tratament ierarhizat precoce şi eficient.

Cuvinte cheie: nefropatie toxică, injurie renală acută, nefrotoxicitate

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Alexandru-Ioan Ulmeanu

ACUTE KIDNEY INJURY IN CHILDREN AND ADOLESCENT POISONING – PREVALENCE, ETIOLOGY AND RISK FACTORS

SELECT ISSUE

Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 1, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

Indexed

DOI - Crossref
Similarity Check by iThenticate, worldwide No 1 professional plagiarism checking system
DOAJ
NLM Catalog
Ebsco Host - Medline
Google Academic
Semantic Scholar

HIGHLIGHTS

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

ACUTE KIDNEY INJURY IN CHILDREN AND ADOLESCENT POISONING – PREVALENCE, ETIOLOGY AND RISK FACTORS

Alexandru-Ioan Ulmeanu, Aurel Bizo and Coriolan Ulmeanu

ABSTRACT

Objectives. The incidence and prevalence of renal disease in actual children poisoning is not fully known because renal structural and functional changes caused by nephrotoxins are nonspecific and toxic etiology is often overshadowed. This study aims to assess the prevalence of toxic nephropathies in a pediatric population, the etiology, clinical and laboratory aspects, prognostic factors, frequency of use of extra renale puration techniques and their impact on survival.

Materials and methods. We conducted an observational, retrospective, multicentric study, over a period of 10 years, between 2003 and 2012, on 82 patients aged 0-18 years from two pediatric poison centers: the department of Toxicology SCUC “Grigore Alexandrescu” Bucharest and the Department of Pediatric Nephrology and Toxicology at the Emergency Clinical Hospital for Children in Cluj-Napoca. In the study group were included patients with acute intoxication who presented acute kidney injury defined by the AKIN criteria.

Results. The etiology of poisoning that have associated acute kidney injury is dominated by drugs – 36.6%, followed by mushrooms – 24,4%, insecticides – 18.3% and alcohols – 11%. In smaller percentages we noted poisonings with caustic substances, hydrocarbons, nitrites and lead. Looking in detail we can observe that for the etiology of drug poisonings multidrug intoxications prevailed followed by poisonings with antibiotics most commonly gentamicin. In the case of multi drug poison ings the substances most frequently involved were: combination of Paracetamol, NSAIDs andMetamizol.In mushroom poisonings, in most cases were involved mushrooms with long incubation period probably Amanita Phalloides. For the Insecticide poisonings the etiology was represented mainly by organophosphorus and carbamate insecticides. The etiology of alcohol poisoning most commonly included cases of ethylenglycol. On the group of 82 cases studied, 26 deaths were recorded, mortality was 32%. We observed that oliguria, anuria, edema, hemorrhagic manifestations, polypnea, signs of shock, coma, and hepatic hepatocytolisis were risk factors for death in our study. The methods of extrarenal epuration or renal replacement treatment were carried out in 41% of cases. They were not protective factors in the study group.

Conclusions. Acute poisoning cases in children show asignificant increasein recent years in our country. The cases oftoxic acute renal injury often have severe prognosis. Associated risk factorsshould be identified and diagnosed quickly to establish aprioritized early and effective treatment.

Keywords: toxic nephropathy, acute kidney injury, nephrotoxicity

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Alexandru-Ioan Ulmeanu


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