A prospective multi-center quality improvement initiative (NINJA) indicates a reduction in nephrotoxic acute kidney injury in hospitalized children

Goldstein, Stuart L.; Dahale, Devesh; Kirkendall, Eric S.; Mottes, Theresa; Kaplan, Heather C.; Muething, Stephen E.; Askenazi, David; Henderson, Traci; Dill, Lynn; Somers, Michael J.; Kerr, Jessica; Gilarde, Jennifer; Zaritsky, Joshua J.; Bica, Valerie; Brophy, Patrick D.; Misurac, Jason; Hackbarth, Richard; Steinke, Julia; Mooney, Joann; Ogrin, Sara L; Chadha, Vimal; Warady, Bradley A.; Ogden, Richard K.; Hoebing, Wendy; Symons, Jordan M.; Yonekawa, Karyn; Menon, Shina; Abrams, Lisa; Sutherland, Scott M.; Weng, Patricia L.; Zhang, Fang; Walsh, Kathleen E.

doi:10.1016/j.kint.2019.10.015

Cited by 119 publications

(117 citation statements)

References 30 publications

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“…Endothelial dysfunction — characterized by high D-dimer levels and microvascular damage — represents a key risk factor for COVID-19-associated coagulopathy. Other inherited or acquired pro-thrombotic conditions, such as thrombotic thrombocytopenic purpura and atypical haemolytic uraemic syndrome might also contribute to endothelial dysfunction and coagulopathy in patients with COVID-19, as might direct viral activation of the complement system 40 , 41 . Importantly, complement activation and thrombotic microangiopathy are important mechanisms of kidney injury.…”

Section: Pathophysiology and Effects Of Treatmentmentioning

confidence: 99%

COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup

et al. 2020

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Kidney involvement in patients with coronavirus disease 2019 (COVID-19) is common, and can range from the presence of proteinuria and haematuria to acute kidney injury (AKI) requiring renal replacement therapy (RRT; also known as kidney replacement therapy). COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and serves as an independent risk factor for all-cause in-hospital death in patients with COVID-19. The pathophysiology and mechanisms of AKI in patients with COVID-19 have not been fully elucidated and seem to be multifactorial, in keeping with the pathophysiology of AKI in other patients who are critically ill. Little is known about the prevention and management of COVID-19 AKI. The emergence of regional ‘surges’ in COVID-19 cases can limit hospital resources, including dialysis availability and supplies; thus, careful daily assessment of available resources is needed. In this Consensus Statement, the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI based on current literature. We also make recommendations for areas of future research, which are aimed at improving understanding of the underlying processes and improving outcomes for patients with COVID-19 AKI.

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Section: Pathophysiology and Effects Of Treatmentmentioning

confidence: 99%

COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup

et al. 2020

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“…Finally, failure to adhere to guideline-based care in severe AKI could be due to lack of awareness of AKI management guidelines or an oversight by providers. If so, these findings reflect an J o u r n a l P r e -p r o o f opportunity to support healthcare providers caring for patients with severe AKI through provision of real-time electronic alerts 8 , involvement of multi-disciplinary care teams 9 , or implementation of care bundles such as those used to prevent central line-associated blood stream infections. 10 11…”

Section: To the Editormentioning

confidence: 88%

Variation in Best Practice Measures in Patients With Severe Hospital-Acquired Acute Kidney Injury: A Multicenter Study

Moledina¹,

Belliveau²,

Yamamoto³

et al. 2021

American Journal of Kidney Diseases

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Signi cant exposure to nephrotoxic medications (nephrotoxic injury negated by just-in-time action = NINJA score): exposure to 3 or more common nephrotoxic medications for 1 day or to aminoglycosides for 3 or more days [19].…”

Section: De Nitionsmentioning

confidence: 99%

Acute Kidney Injury in Children with COVID-19

Kari

Shalaby

Albanna

et al. 2020

Preprint

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Background: Acute kidney injury (AKI) is a complication of coronavirus disease 2019 (COVID-19). The reported incidence of AKI, however, varies among studies. We aimed to evaluate the incidence of AKI and its association with mortality and morbidity in children infected with severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) who required hospital admission.Methods: This was a multicenter retrospective cohort study from three tertiary centers, which included children with confirmed COVID-19. All children were evaluated for AKI using the Kidney Disease Improving Global Outcomes (KDIGO) definition and staging. Results: Of 89 children included, 19 (21%) developed AKI (52.6% stage I). A high renal angina index score was correlated with severity of AKI. Also, multisystem inflammatory syndrome in children (MIS-C) was increased in children with AKI compared to those with normal kidney function (15% vs 1.5%). Patients with AKI had significantly more pediatric intensive care admissions (PICU) (32% vs. 2.8%, p< 0.001) and mortality (42% vs. 0%, p< 0.001). However, AKI was not associated with prolonged hospitalization (58% vs. 40%, p=0.163) or development of MIS-C (10.5% vs. 1.4%, p=0.051). Residual renal impairment at discharge occurred in 9% of patients. This was significantly influenced by the presence of comorbidities, hypotension, hypoxia, heart failure, acute respiratory distress, hypernatremia, abnormal liver profile, high C-reactive protein, and positive blood culture.Conclusions: AKI occurred in one-fifth of children with SARS-CoV-2 infection requiring hospital admission, with one-third of those requiring PICU. AKI was associated with increased morbidity and mortality, and residual renal impairment at time of discharge.

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A prospective multi-center quality improvement initiative (NINJA) indicates a reduction in nephrotoxic acute kidney injury in hospitalized children

Cited by 119 publications

References 30 publications

COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup

COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup

Variation in Best Practice Measures in Patients With Severe Hospital-Acquired Acute Kidney Injury: A Multicenter Study

Acute Kidney Injury in Children with COVID-19

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