Current Concepts of Pediatric Acute Kidney Injury—Are We Ready to Translate Them into Everyday Practice?

Musiał, Kinga

doi:10.3390/jcm10143113

Cited by 10 publications

(11 citation statements)

References 43 publications

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“…This study assessed the predictive accuracy of uCysC at the cutoff of 1.26 mg/g uCr, and clearly showed that the uCysC at the threshold can be used to identify greater risk of AKI in critically ill children at the age of more than 1 month. As we know, defining an efficient and reliable tool for AKI assessment in children is still a challenge, because the pathophysiology of AKI in children can be affected by ongoing tubular development, greater renal reserve, and superior renal regenerative potential compared with adults [ 16 , 17 , 32 ]. Although as a sensitive biomarker for AKI and mortality [ 20 – 22 , 33 , 34 ], the levels of uCysC are inversely correlated with age and body weight in neonates and children [ 21 , 22 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, there remains a gap between these recommendations and the clinical application, and whether elevation in biomarkers without any changes in SCr/oliguria or a change in SCr/oliguria without any change of damage biomarker is associated with worse kidney and patient outcomes remains elusive [ 7 , 8 , 13 – 15 ]. This is particularly true in children, because the results obtained in adults seem difficult to be transferred directly into the pediatric field, where the results and their interpretation are age-dependent [ 16 , 17 ]. The incidence and outcome of AKI substages in critically ill children remain however largely unknown, and whether detecting AKI substages would be relevant with respect to outcome is needed to be investigated.…”

Section: Introductionmentioning

confidence: 99%

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The outcome of acute kidney injury substages based on urinary cystatin C in critically ill children

Chen

Jiang

Huang

et al. 2023

Ann. Intensive Care

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Background The concept of acute kidney injury (AKI) substages has been recommended to better phenotype AKI and identify high-risk patient groups and therefore improve the diagnostic accuracy of AKI. However, there remains a gap between the recommendation and the clinical application. The study aimed to explore the incidence of AKI substages based on a sensitive AKI biomarker of urinary cystatin C (uCysC), and to determine whether AKI substages were relevant with respect to outcome in critically ill children. Results The multicenter cohort study enrolled 793 children in pediatric intensive care unit (PICU) of four tertiary hospitals in China. Children were classified as non-AKI, sub-AKI and AKI substages A and B according to uCysC level at PICU admission. Sub-AKI was defined by admission uCysC level ≥ 1.26 mg/g uCr in children not meeting the KDIGO criteria of AKI. In children who fulfilled KDIGO criteria, those with uCysC < 1.26 was defined as AKI substage A, and with ≥ 1.26 defined as AKI substage B. The associations of AKI substages with 30-day PICU mortality were assessed. 15.6% (124/793) of patients met the definition of sub-AKI. Of 180 (22.7%) patients with AKI, 90 (50%) had uCysC-positive AKI substage B and were more likely to have classical AKI stage 3, compared to substage A. Compared to non-AKI, sub-AKI and AKI substages A and B were risk factors significantly associated with mortality, and the association of sub-AKI (adjusted hazard ratio HR = 2.42) and AKI substage B (adjusted HR = 2.83) with mortality remained significant after adjustment for confounders. Moreover, AKI substage B had increased risks of death as compared with sub-AKI (HR = 3.10) and AKI substage A (HR = 3.19). Conclusions Sub-AKI defined/based on uCysC occurred in 20.2% of patients without AKI and was associated with a risk of death close to patients with AKI substage A. Urinary CysC-positive AKI substage B occurred in 50% of AKI patients and was more likely to have classical AKI stage 3 and was associated with the highest risk of mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The outcome of acute kidney injury substages based on urinary cystatin C in critically ill children

Chen

Jiang

Huang

et al. 2023

Ann. Intensive Care

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“…The major causative factors for CKD were congenital anomalies of the kidney and urinary tract (CAKUT) (45 children), including reflux nephropathy (19 cases), obstructive uropathy (14 patients), and hypo/dysplastic kidneys (12). Other underlying diseases were: chronic glomerulonephritis (10), polycystic kidney disease (4), and hemolytic uremic syndrome (2). CAKUT was the only cause of CKD in CKD I and the dominant cause in CKD II (Table 1).…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…The regenerative potential of renal tubules is clearly seen in the course of acute tubular necrosis, when the increased fractional excretion of sodium results from the timely dysfunction of proximal tubules and allows sequential control until its normalization preceding recovery. The working hypothesis is that similar follow-up of tubular reabsorption capacity is available in the course of chronic kidney disease (CKD) and that it is possible to define a breakthrough point at which reversal of tubular dysfunction is no longer possible [ 2 ]. The breakthrough is usually preceded by compensatory mechanisms aimed at maintaining the status quo.…”

Section: Introductionmentioning

confidence: 99%

Bone Morphogenetic Proteins (BMPs), Extracellular Matrix Metalloproteinases Inducer (EMMPRIN), and Macrophage Migration Inhibitory Factor (MIF): Usefulness in the Assessment of Tubular Dysfunction Related to Chronic Kidney Disease (CKD)

Musiał

Zwołińska

2021

JCM

Self Cite

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Bone morphogenetic proteins (BMP), extracellular matrix metalloproteinases inducer (EMMPRIN), and macrophage migration inhibitory factor (MIF) are known to be closely connected to renal tubule damage by experimental data; however, this has not been analyzed in children with chronic kidney disease (CKD). The aim of this study was to determine their usefulness in the assessment of CKD-related tubular dysfunction. The study group consisted of 61 children with CKD stages 1–5 and 23 controls. The serum and urine concentrations of BMP-2, BMP-6, EMMPRIN, and MIF were assessed by ELISA and their fractional excretion (FE) was calculated. The serum and urine concentrations of BMP-2, BMP-6, EMMPRIN, and MIF were significantly elevated in children with CKD vs. controls. The FE of BMP-2, FE BMP-6, and EMMPRIN increased significantly in CKD stages 1–2, but exceeded 1% in CKD stages 3–5. FE MIF became higher than in controls no sooner than in CKD 3–5, but remained below 1%. The FE values for BMP-2, BMP-6, and EMMPRIN of <1% may result from the tubular adaptive mechanisms, whereas those surpassing 1% suggest irreversible tubular damage. The analysis of serum/urinary concentrations and fractional excretion of examined parameters may allow the assessment of CKD-related tubular dysfunction.

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“…Гіпотеза Бреннера описує гемодинамічні механізми, спрямовані на підтримку екскреторної здатності нирок: нефронний дефіцит підвищує ШКФ кожного окремого нефрону. Ці адаптаційні гемодинамічні зміни спричиняють внутрішньоклубочкову гіпертензію, гломерулярну та тубулярну гіпертрофію, що на фоні редукованої кількості нефронів призводить до розвитку вогнищевого сегментарного гломерулосклерозу, особливо у ПНД з НМТ [43].…”

Section: патофізіологія та патоморфологія ураження нирокunclassified

Perspective Urinary Biomarkers According to Pathogenetic Mechanisms of Acute Kidney Injury in Preterm-Born Children

Hodovanets¹,

Frunza²

2021

Neonatol. hìr. perinat. med.

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Technologies for nursing preterm-born babies have evolved significantly in recent years. However, we still have several unresolved issues, among which acute kidney injury remains one of the most urgent. This pathological clinical syndrome is associated with high rates of morbidity and mortality, especially in premature infants with severe perinatal pathology. Arrester diagnosis is based on the classification proposed in 2012 by the International Expert Group - Kidney Disease: Improving Global Outcomes. The main criteria for verifying the diagnosis of acute renal injury are an increase in serum creatinine levels and a decrease in urine output. The problem of diagnosis and differential diagnosis of acute renal failure in prematurely born children occupies a leading place, because it is still no consensus on the possibilities of using specific biomarkers of kidney damage, and no nomograms are taking into account the gestational age at birth, body weight and the severity of perinatal pathology.Plasma creatinine is still the most commonly used marker of impaired filtration function, but in recent years there have been numerous scientific discussions and new, highly sensitive, and highly specific markers of renal injury. In particular, it was proposed to consider functional biomarkers and markers of tubular damage as separate categories, since impaired renal function and the injury itself can coexist independently, simultaneously, or a transition of categories is observed. Plasma cystatin C, urinary and serum fractions of alpha-1-microglobulin and beta-2-microglobulin, lipocalin associated with neutrophil gelatinase, and others are promising biomarkers. Attention is focused on the importance of the epigenetic concept in the formation of kidney damage, blocking of the renin- angiotensin-aldosterone-antidiuretic hormone system, and the role of transient receptor potential channels in the modulation of basic renal functions. Metabolic urine profiles are widely studied taking into account gestational age and body weight.

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Current Concepts of Pediatric Acute Kidney Injury—Are We Ready to Translate Them into Everyday Practice?

Cited by 10 publications

References 43 publications

The outcome of acute kidney injury substages based on urinary cystatin C in critically ill children

The outcome of acute kidney injury substages based on urinary cystatin C in critically ill children

Bone Morphogenetic Proteins (BMPs), Extracellular Matrix Metalloproteinases Inducer (EMMPRIN), and Macrophage Migration Inhibitory Factor (MIF): Usefulness in the Assessment of Tubular Dysfunction Related to Chronic Kidney Disease (CKD)

Perspective Urinary Biomarkers According to Pathogenetic Mechanisms of Acute Kidney Injury in Preterm-Born Children

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