Epidemiology of acute kidney injury in children worldwide, including developing countries

Abstract

In this review we summarize the world-wide epidemiology of acute kidney injury (AKI) in children with special emphasis on low-income countries, notably those of the sub-Saharan continent. We discuss definitions and classification systems used in pediatric AKI literature. At present, despite some shortcomings, traditional Pediatric Risk Injury Failure Loss and End Stage Kidney Disease (pRIFLE) and Kidney Disease Improving Global Outcomes (KDIGO) systems are the most clinically useful. Alternative definitions, such as monitoring serum cystatin or novel urinary biomarkers, including cell cycle inhibitors, require more long-term studies in heterogenous pediatric AKI populations before they can be recommended in routine clinical practice. A potentially interesting future application of some novel biomarkers could be incorporation into the "renal angina index", a concept recently introduced in pediatric nephrology. The most reliable epidemiological data on AKI in children come from high-outcome countries and are frequently focused on critically ill pediatric intensive care unit populations. In these patients AKI is often secondary to other systemic illnesses or their treatment. Based on a recent literature search performed within the framework of the "AKI 0by25" project of the International Society of Nephrology, we discuss the scarce and often inaccurate data on AKI epidemiology in low-income countries, notably those on the African continent. The last section reflects on some of the many barriers to improvement of overall health care in low-income populations. Although preventive strategies for AKI in low-income countries should essentially be the same as those in high-income countries, we believe any intervention for earlier detection and better treatment of AKI must address all health determinants, including educational, cultural, socio-economic and environmental factors, specific for these deprived areas.

Factors that influenced undergoing renal replacement therapy and survival in children with acute kidney injury

“…Overall mortality rate was 26.9%, but of the 59 dead patients, 11 died after recovery from AKI. Median time for mortality was 8 days (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Overall patient survival rates were 83.6% for 10 days and 47.3% for 28 days.…”

“…Postcardiac surgery, sepsis, multiorgan failure, haemato‐oncological diseases, trauma, and exposure to nephrotoxic agents are the main causes of AKI in the critically ill child, while in the hospitalized non‐critically ill child, exposure to nephrotoxins is a major cause of AKI . Studies on community‐acquired AKI in children remain scarce and are generally based on registries of in hospital populations …”

“…10 Studies on community-acquired AKI in children remain scarce and are generally based on registries of in hospital populations. 11 Optimal therapy of paediatric AKI is unclear and so is the true incidence of it. 12 Conservative treatment of AKI includes management of volume, electrolyte and acid-base homeostasis.…”

Non‐standard criteria donors in pediatric kidney transplantation

“…The AKI‐EPI study, an international cross‐sectional study performed at 97 centers in patients during their first week of ICU admission, showed that 57% of critically ill patients developed AKI . Likewise, the major relevance of AKI among severely ill pediatric patients is also evident, with an AKI prevalence of 25% in this group …”

“…50 Likewise, the major relevance of AKI among severely ill pediatric patients is also evident, with an AKI prevalence of 25% in this group. 51,52 A serious problem among ICU and PICU patients, AKI, is also frequently present in potential DDs. The kidney has an intrinsic capacity to repair itself and recover from an ischemic or toxic insult, 53 and the majority patients with AKI may fully recover their renal function.…”