Prolonged renal tubular injury following acute kidney injury in an infant treated with blood purification therapy

Abstract

【BACKGROUND】 The long-term renal outcome in infants after acute kidney injury (AKI) remains unclear. We report the case of an infant with chronic renal tubular injury after AKI. 【CASE】 An 18-day-old male with acute cellulitis of the heel was admitted to hospital. Antibiotics were administered. On day 27, an abscess and osteomyelitis developed, and surgical drainage was performed. On day 28, he presented with hemorrhagic shock because of bleeding from the drainage. He was transferred to our hospital. He presented lethargy, oliguria, hyperkalemia and coagulation disorder. There was no arrhythmia and electrocardiogram was normal; insulin-glucose therapy was initiated. His circulatory condition stabilized however, he presented with hyperkalemia and oliguria; both improved promptly following blood purification therapy from day 29 for two days. His glomerular injury improved within one month, but the tubular injury persisted. Hyponatremia developed due to the increase in urinary sodium excretion, and sodium chloride was administered. His tubular injury persisted without administration of sodium chloride at 3 years old. 【CONCLUSIONS】 Renal function in infancy is maturing, and assessment of renal function after AKI is difficult. We need to establish a long-term follow-up system for children with severe AKI.