Introduction: Acute kidney injury in pediatric patients (pAKI) is common in developing countries and leads to significant morbidity and mortality. Most nephrology services in developing countries are only in larger cities and for that reason many cases remain undiagnosed. We evaluated the performance of a saliva urea nitrogen (SUN) dipstick to diagnose pAKI in Sudan. Methods: We collected demographic and clinical information, serum creatinine (SCr), blood urea nitrogen (BUN), SUN, and urine output (UO) in children with pAKI. pAKI was diagnosed based on different criteria (Risk, Injury, Failure, Loss of kidney function, and end-stage kidney disease, Acute Kidney Injury Network and Kidney Disease Improving Global Outcomes). We also recorded hospital and 3-months’ mortality and progression to chronic kidney disease (CKD) as outcomes. Results: We studied 81 patients (mean age 10.7 ± 7 years, 51.9% females) and divided them by age into (a) neonates (<120 days; n = 21; 25.9%); (b) -infants (120–365 days; n = 18; 25.9%); and (c) children (>365 days; n = 42; 53.1%). Diagnosis using different pAKI definitions resulted in differences in AKI staging. SUN reliably reflected BUN over the entire study period, regardless of treatment modality or pAKI severity. Neither pAKI staging, SUN, BUN, nor SCr were associated with mortality or progression to CKD. UO predicted all-cause mortality during the 3-months follow-up. Conclusion: Diagnosis of pAKI using different criteria differs in triage and staging. SUN reflects BUN particularly at higher BUN levels and allows monitoring of treatment responses. Despite the lack of predictive power of SUN to predict hard outcomes, measurement of SUN by dipstick can be used to identify, screen, and monitor pediatric patients with pAKI.

Keywords:
Acute kidney injury, Blood urea nitrogen, Developing countries, Diagnostic tools, Saliva urea nitrogen, Saliva dipstick
1.
Lameire NH, Bagga A, Cruz D, De Maeseneer J, Endre Z, Kellum JA, et al. Acute kidney injury: an increasing global concern.
Lancet
. 2013 Jul;382(9887):170–9.
2.
Goldstein SL. Acute kidney injury in children and its potential consequences in adulthood.
Blood Purif
. 2012;33(1-3):131–7.
3.
Cerda J, Bagga A, Kher V, Chakravarthi RM. The contrasting characteristics of acute kidney injury in developed and developing countries.
Nat Clin Pract Nephrol
. 2008 Mar;4(3):138–53.
4.
Cerda J, Lameire N, Eggers P, Pannu N, Uchino S, Wang H, et al. Epidemiology of acute kidney injury.
Clin J Am Soc Nephrol
. 2008 May;3(3):881–6.
5.
Mehta RL, Cerdá J, Burdmann EA, Tonelli M, García-García G, Jha V, et al. International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology.
Lancet
. 2015 Jun;385(9987):2616–43.
6.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al.; Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury.
Crit Care
. 2007;11(2):R31.
7.
Ball EF, Kara T. Epidemiology and outcome of acute kidney injury in New Zealand children.
J Paediatr Child Health
. 2008 Nov;44(11):642–6.
8.
Hui-Stickle S, Brewer ED, Goldstein SL. Pediatric ARF epidemiology at a tertiary care center from 1999 to 2001.
Am J Kidney Dis
. 2005 Jan;45(1):96–101.
9.
Vachvanichsanong P, Dissaneewate P, Lim A, McNeil E. Childhood acute renal failure: 22-year experience in a university hospital in southern Thailand.
Pediatrics
. 2006 Sep;118(3):e786–91.
11.
Abdelraheem M, Ali el T, Osman R, Ellidir R, Bushara A, Hussein R, et al. Outcome of acute kidney injury in Sudanese children - an experience from a sub-Saharan African unit.
Perit Dial Int
. 2014 Jul-Aug;34(5):526–33.
12.
Kaballo BG, Khogali MS, Khalifa EH, Khaiii EA, Ei-Hassan AM, Abu-Aisha H. Patterns of &quot;severe acute renal failure&quot; in a referral center in Sudan: excluding intensive care and major surgery patients.
Saudi J Kidney Dis Transpl
. 2007 Jun;18(2):220–5.
13.
Naicker S. End-stage renal disease in sub-Saharan Africa.
Ethn Dis
. 2009 Spring;19(1 suppl 1):S1–13.
14.
Raimann JG, Riella MC, Levin NW. International Society of Nephrology’s 0by25 initiative (zero preventable deaths from acute kidney injury by 2025): focus on diagnosis of acute kidney injury in low-income countries.
Clin Kidney J
. 2018 Feb;11(1):12–9.
15.
Calice-Silva V, Vieira MA, Raimann JG, Carter M, Callegari J, Levin NW, et al. Saliva urea nitrogen dipstick - a novel bedside diagnostic tool for acute kidney injury.
Clin Nephrol
. 2014 Dec;82(6):358–66.
16.
Evans R, Calice-Silva V, Raimann JG, Hemmila U, Craik A, Mtekateka M, et al.; International Society of Nephrology (ISN) 0by25 Initiative. Diagnostic Performance of a Saliva Urea Nitrogen Dipstick to Detect Kidney Disease in Malawi.
Kidney Int Rep
. 2016 Dec;2(2):219–27.
17.
Evans RD, Cooke W, Hemmila U, Calice-Silva V, Raimann J, Craik A, et al. A Salivary Urea Nitrogen Dipstick to Detect Obstetric-Related Acute Kidney Disease in Malawi.
Kidney Int Rep
. 2017 Oct;3(1):178–84.
18.
Raimann JG, Calice-Silva V, Thijssen S, Nerbass FB, Vieira MA, Dabel P, et al. Saliva Urea Nitrogen Continuously Reflects Blood Urea Nitrogen after Acute Kidney Injury Diagnosis and Management: Longitudinal Observational Data from a Collaborative, International, Prospective, Multicenter Study.
Blood Purif
. 2016;42(1):64–72.
19.
Raimann JG, Kirisits W, Gebetsroither E, Carter M, Callegari J, Rosales L, et al. Saliva urea dipstick test: application in chronic kidney disease.
Clin Nephrol
. 2011 Jul;76(1):23–8.
20.
Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents.
Pediatr Clin North Am
. 1987 Jun;34(3):571–90.
21.
R Development Core Team.
R: A language and environment for statistical computing
. Vienna, Austria: R Foundation for Statistical Computing; 2015.
22.
Mehta RL, Burdmann EA, Cerdá J, Feehally J, Finkelstein F, García-García G, et al. Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study.
Lancet
. 2016 May;387(10032):2017–25.
23.
Chang JW, Jeng MJ, Yang LY, Chen TJ, ­Chiang SC, Soong WJ, et al. The epidemiology and prognostic factors of mortality in critically ill children with acute kidney injury in Taiwan.
Kidney Int
. 2015 Mar;87(3):632–9.
24.
Olowu WA, Niang A, Osafo C, Ashuntantang G, Arogundade FA, Porter J, et al. Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review.
Lancet Glob Health
. 2016 Apr;4(4):e242–50.
25.
Karlowicz MG, Adelman RD. Nonoliguric and oliguric acute renal failure in asphyxiated term neonates.
Pediatr Nephrol
. 1995 Dec;9(6):718–22.
26.
Rudolph AM, Heymann MA. The fetal circulation.
Annu Rev Med
. 1968;19(1):195–206.
27.
Sutherland SM, Byrnes JJ, Kothari M, Longhurst CA, Dutta S, Garcia P, et al. AKI in hospitalized children: comparing the ­pRIFLE, AKIN, and KDIGO definitions.
Clin J Am Soc Nephrol
. 2015 Apr;10(4):554–61.
28.
Calice da Silva V, Raimann JG, Wu W, Pecoits-Filho R, Kotanko P, Levin NW. Salivary Urea Nitrogen as a Biomarker for Renal Dysfunction. In: Patel V, editor.
Biomarkers in Kidney Disease Springer
. Dordrecht; 2016. pp. 1–19.
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2019
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