Diabetic ketoacidosis with acute kidney injury in prepubertal children: a report on two cases
Abstract: Type 1 diabetes
mellitus is a result of autoimmune damage, in which environ thought to trigger
the autoimmune destruction of pancreatic ß-cells.1,2mental factors are
Worldwide, an estimated 65,000 children under 15 years of age develop type 1
diabetes mellitus each year.3 Approximately 30%of children who present with
newly-diagnosed type 1diabetes have diabetic ketoacidosis (DKA).4 Himawanet al.
reported a DKA prevalence of43.6% in girls.5 The long-term effects of diabetes
mellitus include retinopathy, chronic kidney disease (nephropathy), neuropathy,
anddyslipidemia.
In Indonesia, DKA is often unidentified and therapy inadequate, due to
several factors such asa dearth of health care facilities in remote areas, aculture
of avoiding doctors, financial constraints, and regulations governing access to
care. These factors may lead to late diagnoses and even fatalities. TheDKA
occurs in 10-70% of children with type 1 diabetesmellitus and has a significant
risk of mortality due tocerebral edema and other potential complications such as
acute renal failure (ARF)/acute kidney injury (AKI). Asl et al. in Iran,
reported that 4.7% of children with DKA had acute renal failure. Acute kidney
injury, though it rarely develops in DKA patients, may be severe and
potentially life-threatening in critically ill children.6 The AKI is defined as
a syndrome where the kidneys fail to adequately regulate electrolytes, as well
as acid–base and fluid homeostasis, with concomitant reduction in glomerular
filtration rate
(GFR).8 The mortality rate of AKI is up to 60% in critically ill
children, and influenced by the severity ofthe primary diseases, organ
dysfunction, and stage of AKI.9,10 Classification of AKI are determined
according pediatric RIFLE (pRIFLE) criteria. Here, we present two cases of
prepubertal girls with poorly controlled type 1 diabetes mellitus, who were
diagnosed with DKA and AKI.
Keywords: diabetic
ketoacidosis; acute kidney injury; prepubertal children; type 1 diabetes
mellitus
Author: Dwi Andriyani, Afriyan Wahyudhi, Shirley Leonita Anggriawan
Journal Code: jpkedokterangg160189
