Study on the Intervention and Prognosis of Modified Lifting Powder on Acute Kidney Injury and Acute Kidney Disease in Children

Background The transition stage from acute kidney injury (AKI) to chronic kidney disease (CKD) is referred to as acute kidney disease (AKD). Currently, there are relatively few studies on the intervention of traditional Chinese medicine in the progression of AKI to AKD in children. Objective To explore the intervention effect and impact on prognosis of Modified Shengjiang Powder on AKI and AKD in children. Methods A total of 136 children with AKI admitted to the Department of Pediatrics of Jinling Hospital Affiliated to Medical College of Nanjing University from June 2017 to June 2022 were selected and divided into the treatment group (65 cases) and the control group (71 cases) by random number method. The control group was treated with conventional Western medicine, while the children in the treatment group were treated with oral Modified Shengjiang Powder decoction in addition to Western medicine. Laboratory examination indicators were collected from the children at 7 days and 14 days after treatment, and the TCM syndrome score was evaluated at 14 days after treatment. The AKI children were re-evaluated after 7 days of treatment. The children were followed up for 3 to 60 months after treatment. Univariate and multivariate Cox regression analyses were used to explore the risk factors for AKI children progressing to AKD and the risk factors for AKD children progressing to CKD stage 3. The Kaplan-Meier method was used to draw the survival curve of the cumulative survival rate of the children, and the Log-rank test was used for survival curve comparison. Results A total of 136 AKI children were included, including 81 boys and 55 girls, with an average age of (12.6±4.5) years. After 7 days of treatment, a total of 67 children progressed to AKD, among which 26 children in the treatment group and 41 children in the control group progressed to AKD. According to the previous AKI grouping and treatment results, the AKD children were divided into the AKD treatment sub-group (26 cases) and the AKD control sub-group (41 cases) again. After treatment, the levels of serum creatinine (Scr), blood urea nitrogen (BUN), uric acid (UA), urinary N-acetyl-β-D-glucosaminidase (NAG) enzyme, urinary retinol-binding protein (RBP), urinary neutrophil gelatinase-associated lipocalin (NGAL), TCM syndrome score, and the proportion of CKD stage 3 in the treatment group were lower than those in the control group, while the estimated glomerular filtration rate (eGFR) and the proportion of complete recovery of AKI were higher than those in the control group (P<0.05). After 14 days of treatment for AKD children, the levels of Scr, urinary NAG enzyme, urinary NGAL, the proportion of CKD stage 3, and end-stage renal disease (ESRD) in the AKD treatment sub-group were lower than those in the AKD control sub-group (P<0.05). The results of multivariate Cox regression analysis showed that urinary NAG enzyme≥9.7 U·g-1·Cr-1 was a risk factor for AKI children progressing to AKD (HR=2.724, 95%CI=1.886-4.519, P=0.007), and traditional Chinese medicine treatment was a protective factor for AKI children progressing to AKD (HR=0.482, 95%CI=0.319-0.843, P=0.008) ; stage 3 of AKD was a risk factor for AKD children progressing to CKD stage 3 (HR=2.865, 95%CI=2.213-3.619, P=0.011), and traditional Chinese medicine treatment was a protective factor for AKD children progressing to CKD stage 3 (HR=0.665, 95%CI=0.422-0.953, P=0.040). At the end of the treatment course, the risk of progression to AKD in the AKI treatment group was lower than that in the AKI control group (χ2=5.343, P=0.021) ; at 90 days of follow-up, the risk of progression to CKD stage 3 in the AKI treatment group was lower than that in the AKI control group (χ2=4.623, P=0.032), and the risk of progression to CKD stage 3 in the AKD treatment group was lower than that in the AKD control group (χ2=7.409, P=0.006) ; at the end of the follow-up, the renal survival rate in the AKD treatment group was higher than that in the AKD control group (χ2=8.133, P=0.004) . Conclusion MLD can delay the progression of AKI and AKD, protect renal function and improve prognosis.