The Clinical Features and Risk Factors of Acute Kidney Injury in Children with Acute Paraquat Intoxication

Objective: The aim of this study was to investigate the clinical characteristics and risk factors of acute kidney injury (AKI) in children with acute paraquat intoxication.

Methods: A retrospective study of 110 hospitalized children with acute paraquat intoxication in West China Second University Hospital, Sichuan University, was conducted from January 2010 to May 2017. The Kaplan-Meier method was used to compare the survival rates of children with different AKI stages. Multivariate logistic regression was applied to analyse the risk factors for paraquat-induced AKI.

Results: AKI occurred in 42 out of 110 children (38.2%). Among these cases, we observed AKI stage 1 in 2 cases (4.8%), AKI stage 2 in 11 cases (26.2%), and AKI stage 3 in 29 cases (69.0%). The survival rate of children in AKI stage 3 (34.5%) was significantly lower than that of those in AKI stage 2 (63.6%) and AKI stage 1 (100%) (P < 0.001). Compared with the non-AKI group, there were significant differences in vomiting, abdominal pain, oral ulcer, peripheral white blood cell count, neutrophil percentage, alanine aminotransferase, aspartate aminotransferase, total bilirubin, serum sodium, serum potassium and lactate dehydrogenase in the AKI group (P<0.05). Compared with the non-AKI group, the AKI group was more severe according to clinical type and had a lower paediatric critical illness score. Univariate analysis showed that age > 6 years old, vomiting, abdominal pain, gastrointestinal bleeding, oral ulcer, hypoproteinaemia, increased total white blood cell count, increased percentage of neutrophils, hyponatraemia, hypokalaemia and elevated glutamic-pyruvic aminotransferase were risk factors for paraquat-induced AKI in children. Multivariate analysis showed that oral ulcers and elevated blood glucose were independent risk factors for paraquat-induced AKI in children (OR=4.223 and 5.545, respectively, P < 0.05).

Conclusions: The progress of the condition is directly related to the severity of paraquat-induced AKI in children. Oral ulcers and elevated blood glucose are independent risk factors affecting the occurrence of AKI in children with acute paraquat intoxication.