Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

Abstract

Acute kidney injury (AKI) in the pediatric intensive care unit (PICU) is an important risk factor for increased morbidity and mortality during hospitalization. Over the past decade, accumulated data on children and young people indicates that acute episodes of kidney dysfunction can have lasting consequences on multiple organ systems and health outcomes. To date, there are no guidelines for follow-up of surviving children that may be at risk of long-term sequelae following AKI in the PICU. This narrative review aims to describe literature from the last 5 years on the risk of medium and long-term kidney and non-kidney outcomes after AKI in the PICU. More specifically, we will focus on outcomes in children and young people following AKI in the general PICU population and children undergoing cardiac surgery. These outcomes include mortality, hypertension, proteinuria, chronic kidney disease, and healthcare utilization. We also aim to highlight current gaps in knowledge in medium and long-term outcomes in this pediatric population. We suggest a framework for future research to develop evidence-based guidelines for follow-up of children surviving an episode of critical illness and AKI.

Kidney and Blood Pressure Outcomes 11 Years After Acute Kidney Injury in Critically Ill Children: A Prospective Cohort Study

“…Univariable analyses suggested that more severe AKI (stage 2 or worse) was even more strongly associated with 11-year outcomes, suggesting a "dose-response" effect. These ndings are consistent with previous studies with shorter follow-up [17,19,[41][42][43][44][45] . However, our ndings also suggest that the impact of AKI may somewhat wane over time; Robinson et al also found that the impact of AKI on incident CKD and HTN diagnoses lessened with time [19].…”

Rapid bilateral pulmonary artery banding: A developmentally based proposal for the management of neonates with hypoplastic left heart

“…Complications are common, including consequences of invasive catheters, mechanical ventilation, injury to the recurrent laryngeal and phrenic nerves, infection, necrotizing enterocolitis, unplanned procedures, and many more (see Table 1 ). In addition to these short-term consequences, these complications can also contribute to long-term challenges such as ventricular dysfunction, E19 , E20 , E21 , E22 atrioventricular valve regurgitation, E23 , E24 , E25 vascular access limitations, neurodevelopmental challenges, E26 , E27 , E28 chronic kidney disease, E29 , E30 , E31 , E32 , E33 hypertension, E34 proteinuria, E34 gastrointestinal complications, E8 , E35 , E36 , E37 and abnormal lung function. E20 , E38 , E39 Considering the high mortality and morbidity subsequent to surgical intervention for HLHS, the need for a fundamental change in the management of these patients should be considered, utilizing the components of all 3 currently used approaches, with a specific emphasis on minimizing morbidity as well as improving short-term survival.…”

Adults are just big kids: pediatric considerations for adult critical care nephrology

“…The link between pediatric AKI and the development of chronic kidney disease (CKD) has been well established in pediatric patients [8,10,45–49,50 ▪▪ ]. A recent study found that children with kidney failure had a loss of substantial numbers of potential life years, which was most notable in those who had kidney failure at younger ages [51 ▪ ].…”