Diabetic ketoacidosis with acute kidney injury in prepubertal children: a report on two cases

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Dwi Andriyani
Afriyan Wahyudhi
Shirley Leonita Anggriawan


Type 1 diabetes mellitus is a result of autoimmune damage, in which environmental factors are thought to trigger the autoimmune destruction of pancreatic ß-cells.1,2 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 1 diabetes have diabetic ketoacidosis (DKA).4 Himawan et al. reported a DKA prevalence of43.6% in girls.5 The long-term effects of diabetes mellitus include retinopathy, chronic kidney disease (nephropathy), neuropathy, and dyslipidemia.2

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How to Cite
Andriyani D, Wahyudhi A, Anggriawan S. Diabetic ketoacidosis with acute kidney injury in prepubertal children: a report on two cases. PI [Internet]. 16Jan.2017 [cited 31Mar.2020];56(6):360-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/110
Case Report
Received 2016-07-21
Accepted 2016-12-14
Published 2017-01-16


1. Hay WW, Levin MJ, Deterding RR, Abzug MJ, Sondheimer JM. Current diagnosis and treatment pediatrics. In: Rewers M, Chase HP, Eisenbarth GS, editors. Diabetes Mellitus. 21st ed. New York: McGraw-Hill; 2012. p. 1053 - 59.
2. Aschner P, Horton E, Leiter LA, Munro N, Skyler JS. Practical steps to improving the management of type 1 diabetes : recommendations from the global partnership for effective diabetes management. Int J Clin Pract. 2010;64:295-304.
3. Usher-Smith JA, Thompson MJ, Sharp SJ, Walter FM. Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review. BMJ. 2011;343:1-16.
4. Silverstein J, Klingensmith G, Copeland K, Plotnick L, Kaufman F, Laffei L, et al. Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care. 2005;28:186-212.
5. Himawan IW, Pulungan AB, Tridjaja B, Batubara JRL. Komplikasi jangka pendek dan jangka panjang diabetes mellitus tipe 1. Sari Pediatri. 2009;10:367-72.
6. Al-Matrafi J, Vethamuthu J, Feber J. Severe acute renal failure in a patient with diabetic ketoacidosis. Saudi J Kidney Dis Transpl. 2009;20:831-4.
7. Poovazhagi V. Risk factors for mortality in children with diabetic ketoacidosis from developing countries. World J Diabetes. 2014;5:932-8.
8. Walters S, Porter C, Brophy PD. Dialysis and pediatric acute kidney injury: choice of renal support modality. Pediatr Nephrol. 2009;24:37-48.
9. Goldstein SL. Acute kidney injury biomarkers: renal angina and the need for a renal tropinin I. BMC Med. 2011;9:135.
10. Leteurtre S, Duhamel A, Grandbastein B, Proulx F, Cotting J, Gottesman R, et al. Daily estimation of the severity of multiple organ dysfunction syndrome in critically ill children. CMAJ. 2010;182:1181-7.
11. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71:1028-35.
12. Centers for Disease Control and Prevention (CDC). 2000 CDC growth charts for the United States: methods and development. 2002;246:1-189.
13. IDAI. Rekomendasi Ikatan Dokter Anak Indonesia. Asuhan nutrisi pediatrik. Cetakan Pertama. Jakarta: UKK Nutrisi dan Penyakit Metabolik; 2011. p. 1-14.
14. Kotori VM, Gashi N, Toro H. Severe ketoacidosis at onset of type 1 diabetes in children due to late diagnosis. Diabetologia Croatica. 2007;36:59-65.
15. Pischke MA. Diabetic ketoacidosis. Physician Assistant. 2001;25:42-8.
16. Akbay S, Yel A, Yildirimer Ü, Can Ş, Dϋndar B. Diabetic ketoacidosis presenting with pseudonormoglycemia in a 15-year-old girl with type 1 diabetes mellitus. J Clin Res Pediatr Endocrinol. 2013;5:133-5.
17. Espes D, Engstrӧm J, Reinius H, Carlsson P. Severe diabetic ketoacidosis in combination with starvation and anorexia nervosa at onset of type 1 diabetes : a case report. Ups J of Med Sci. 2013;118:130-3.
18. Onyiriuka AN, Ifebi E. Ketoacidosis at diagnosis of type 1 diabetes in children and adolescent: frequency and clinical characteristics. J Diabetes Metab Disord. 2013;12:47.
19. Razavi Z. Frequency of ketoacidosis in newly diagnosed type 1 diabetic children. Oman Med J. 2010;25:114-7.
20. Seth P, Kaur H, Kaur M. Clinical profile of diabetic ketoacidosis: a prospective study in a tertiary care hospital. J Clin Diagn Res. 2015;9:1-4.
21. Fishbein H, Palumbo PJ. Acute metabolic complications in diabetes. Assess from Http://diabetes.niddk.nih.gov/dm/pubs/america/pdf/chapter13.pdf
22. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Wherrett D, Huot C, Mitchell B, Pacaud D. Type 1 diabetes in children and adolescent. Can J Diabetes. 2013;37:S153-62.
23. Ansari N. Peritoneal dialysis in renal replacement therapy for patients with acute kidney injury. Int J Nephrol. 2011;2011:1-10.
24. Orban JC, Maizière EM, Ghaddab A, Van Obberghen E, Ichai C. Incidence and characteristics of acute kidney injury in severe diabetic ketoacidosis. PloS One. 2014;9:1-5.
25. Chantler C, Barrat TM. Laboratory evaluation. In: Holliday MA, Baratt TM, Vernier RL, editors. Pediatric nephrology. 2nd ed. Baltimore: Williams & Wilkins; 1997. p. 282-99.
26. Bresolin N, Silva C, Halllal A, Toporovski J, Fernandez V, Góes J, et al. Prognosis for children with acute kidney injury in the intensive care unit. Pediatr Nephrol. 2009;24:537–44.
27. Hui WF, Chan WKY, Miu TY. Acute kidney injury in the paediatric intensive care unit: identification by modified RIFLE criteria. Hong Kong Med J. 2013;19:13-9.
28. Plötz FB, Bouma AB, van Wijk JA, Kneyber MC, Bökenkamp A. Pediatric acute kidney injury in the ICU: an independent evaluation of pRIFLE criteria. Intensive Care Med. 2008;34:1713–717.
29. 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;34:571-90.
30. Bayazit AK, Yϋksel B, Noyan A, Ӧnenli N, Gӧnlϋșen G, Ӧzer G, et al. Early onset of diabetic nephropathy in a child with type 1 diabetes mellitus. Turk J Pediatr. 2003;45: 55-8.
31. Bogdanovic R. Diabetic nephropathy in children. Nephrol Dial Transplant. 2001;16:120-2.
32. Hahn SJ, Park JH, Lee JH, Lee JK, Kim KA. Severe hypertriglyceridemia in diabetes ketoacidosis accompanied by acute pancreatitis: case report. J Korean Med Sci. 2010;25:1375-8.
33. Hasan MA. Diabetic nephropathy in childhood and adolescence. Saudi J Kidney Dis Transplant. 2002;13:155-62.
34. Luma GB, Spiotta RT. Hypertension in children and adolescents. Am Fam Physician. 2006;73:1558-68.
35. Iglesias P, Dı´ez JJ. Insulin therapy in renal disease. Diabetes Obes Metab. 2008;10:811-23.
36. Fischbach M, Edefonti A, Schrӧder C, Watson A. Hemodialysis in children: general practical guidelines. Pediatr Nephrol. 2005; 20:1054-66.
37. Shahab I, Khanna R, Nolph KD. Peritoneal dialysis or hemodialysis? A dilemma for the nephrologist. Adv Perit Dial. 2006;22:180-5.
38. Alkan T, Akҫevin A, Türkoğlu H, Parker T, Şaşmazel A, Bayer V, et al. Postoperative prophylactic peritoneal dialysis in neonates and infants after complex congenital cardiac surgery. ASAIO J. 2006; 52:693–7.
39. Flynn JT. Choice of dialysis modality for management of pediatric acute renal failure. Pediatr Nephrol. 2002;17:61–9.