We aimed to determine the prevalence of acute kidney injury (AKI) and to identify factors associated with its development in children presenting with a first febrile or non-febrile tonic–clonic seizure. We conducted an exploratory retrospective study including children (< 18 years) presenting to the emergency department for a first episode of febrile or non-febrile tonic–clonic seizure between January 2021 and July 2025. AKI was defined according to KDIGO serum creatinine criteria, using back-calculating methods to estimate baseline creatinine. Clinical, laboratory, and therapeutic variables were collected. Logistic regression analyses were performed to identify factors associated with AKI. A total of 190 children (mean age 4.2 ± 3.7 years) were included; 112 (58.9%) presented with febrile seizures. AKI occurred in 23 patients (12.1%), with similar prevalence in febrile and non-febrile seizures (12.5% vs. 11.5%; p = 0.84). No patient required renal replacement therapy. Among children with febrile seizures, being born small for gestational age (SGA), elevated C-reactive protein (CRP) levels, and prior use of combined paracetamol and ibuprofen were independently associated with AKI. In the non-febrile seizure subgroup, longer seizure duration and higher CRP levels were associated with AKI in univariate analysis, but only CRP remained independently associated in multivariable model.Conclusion: AKI occurs in approximately 12% of children presenting with a first tonic–clonic seizure. Elevated CRP levels were associated with AKI in both febrile and non-febrile seizures, while SGA status and combined use of antipyretics were associated with AKI among children with febrile seizures. Given the limited number of events, these findings should be interpreted as exploratory. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> What is Known: • Acute kidney injury (AKI) has been anecdotally reported in patients with status epilepticus, likely related to rhabdomyolysis-induced nephropathy. • No studies have systematically investigated this association in either adults or children. What is New: • Approximately 12% of children presenting with a fi rst febrile or non-febrile tonic–clonic seizure develop acute kidneyinjury (AKI). • Elevated C-reactive protein (CRP) levels are independently associated with AKI in both febrile and non-febrileseizures, whereas small-for-gestational-age status and prior combined use of paracetamol and ibuprofen areadditional factors associated with AKI in children with febrile seizures. </entry> </row> </tbody> </tgroup> </Table>

Prevalence and factors associated with acute kidney injury in children presenting to the emergency department with a first tonic–clonic seizure: an exploratory study

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2026年5月22日

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Pierluigi Marzuillo,
Manuela Cerrone,
Anna Di Sessa,
Paola Tirelli,
Giulio Rivetti,
Giusy Capasso,
Rosa Melone,
Emanuele Miraglia del Giudice,
Stefano Guarino,
Felice Nunziata

摘要

We aimed to determine the prevalence of acute kidney injury (AKI) and to identify factors associated with its development in children presenting with a first febrile or non-febrile tonic–clonic seizure. We conducted an exploratory retrospective study including children (< 18 years) presenting to the emergency department for a first episode of febrile or non-febrile tonic–clonic seizure between January 2021 and July 2025. AKI was defined according to KDIGO serum creatinine criteria, using back-calculating methods to estimate baseline creatinine. Clinical, laboratory, and therapeutic variables were collected. Logistic regression analyses were performed to identify factors associated with AKI. A total of 190 children (mean age 4.2 ± 3.7 years) were included; 112 (58.9%) presented with febrile seizures. AKI occurred in 23 patients (12.1%), with similar prevalence in febrile and non-febrile seizures (12.5% vs. 11.5%; p = 0.84). No patient required renal replacement therapy. Among children with febrile seizures, being born small for gestational age (SGA), elevated C-reactive protein (CRP) levels, and prior use of combined paracetamol and ibuprofen were independently associated with AKI. In the non-febrile seizure subgroup, longer seizure duration and higher CRP levels were associated with AKI in univariate analysis, but only CRP remained independently associated in multivariable model.

Conclusion: AKI occurs in approximately 12% of children presenting with a first tonic–clonic seizure. Elevated CRP levels were associated with AKI in both febrile and non-febrile seizures, while SGA status and combined use of antipyretics were associated with AKI among children with febrile seizures. Given the limited number of events, these findings should be interpreted as exploratory.

What is Known:

• Acute kidney injury (AKI) has been anecdotally reported in patients with status epilepticus, likely related to rhabdomyolysis-induced nephropathy.

• No studies have systematically investigated this association in either adults or children.

What is New:

• Approximately 12% of children presenting with a fi rst febrile or non-febrile tonic–clonic seizure develop acute kidneyinjury (AKI).

• Elevated C-reactive protein (CRP) levels are independently associated with AKI in both febrile and non-febrileseizures, whereas small-for-gestational-age status and prior combined use of paracetamol and ibuprofen areadditional factors associated with AKI in children with febrile seizures.