Incidence, risk factors and clinical outcomes for acute kidney injury after aortic arch repair in paediatric patients

Jang, Woo Sung; Choi, Kwang-Dong; Nam, Jin Hae; Jung, Joon Chul; Kwon, Bo Sang; Kim, Jun Seok; Kang, Hee Gyung; Lee, Jeong Ryul; Kim, Yong Jin

doi:10.1093/ejcts/ezu132

Cited by 25 publications

(23 citation statements)

References 22 publications

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“…8 There are several equations that are important for the evaluation of AKI: Schwartz formula 9 for the calculation of the estimated creatinine clearance (eCCr) is, eCCr Z 0.413 Â height (cm)/serum creatinine It was reported that the eCCr values during the three days of the intensive care unit (ICU) stay showed a significant difference among the three groups of non-AKI, AKI-R and AKI-I groups. 10 according to the updated Schwartz formula. The creatinine value was measured by enzymatic method, which is rarely used in Taiwan, where most labs use the Jaffe method.…”

Section: Classification and Staging Of Acute Kidney Injurymentioning

confidence: 99%

“…It is noteworthy mentioning that in case of severe coarctation of aorta, the decreased blood flow to the kidney could be caused by the decreased patent ductus arteriosus flow and left ventricle dysfunction below the aortic arch level. 10 The decrease in milrinone dose and/or addition of a pure vasoconstrictor increased mean arterial pressure while decreasing inotrope score, and thereby potentially reduce the risk of AKI. 38…”

Section: Risk Factors For Acute Kidney Injurymentioning

confidence: 99%

“…Higher risk adjustment for congenital heart surgery (RACHS-1) scores (3 and above) 12,13 Presence of cyanotic lesions 10 Uncorrected or residual cardiac defects 4 Cardiopulmonary bypass (nonpulsatile flow; inflammatory cascade) 12 Longer cardiopulmonary bypass time 12 Hypothermic circulatory arrest 34 Requirement of inotropic support 10,12 Low cardiac output syndrome 12 Prolonged ventilator requirement 14 Need for extracorporeal membrane oxygenation (ECMO) 35 Early fluid overload 14…”

Section: Hemodynamicmentioning

confidence: 99%

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Acute kidney injury after pediatric cardiac surgery

Yuan

2019

Pediatrics & Neonatology

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Acute kidney injury (AKI) is a common complication of pediatric cardiac surgery and is associated with increased morbidity and mortality. Literature of AKI after pediatric cardiac surgery is comprehensively reviewed in terms of incidence, risk factors, biomarkers, treatment and prognosis. The novel RIFLE (pediatric RIFLE for pediatrics), Acute Kidney Injury Network (AKIN) and Kidney Disease Improving Global Outcomes (KDIGO) criteria have brought about unified diagnostic standards and comparable results for AKI after cardiac surgery. Numerous risk factors, either renal or extrarenal, can be responsible for the development of AKI after cardiac surgery, with low cardiac output syndrome being the most pronounced predictor. Early fluid overload is also crucial for the occurrence of AKI and prognosis in pediatric patients. Three sensitive biomarkers, neutrophil gelatinase-associated lipocalin, cystatin C (CysC) and liver fatty acid-binding protein, are regarded as the earliest (increase at 2-4 h), and another two, kidney injury molecule-1 and interleukin-18 represent the intermediate respondents (increase at 6-12 h after surgery). To ameliorate the cardiopulmonary bypass techniques, improve renal perfusion and eradicate the causative risk factors are imperative for the prevention of AKI in pediatric patients. The early and intermediate biomarkers are helpful for an early judgment of occurrence of postoperative AKI. Improved survival has been achieved by prevention, renal support and modifications of hemofiltration techniques. Further development is anticipated in small children.

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Section: Classification and Staging Of Acute Kidney Injurymentioning

confidence: 99%

Section: Risk Factors For Acute Kidney Injurymentioning

confidence: 99%

Section: Hemodynamicmentioning

confidence: 99%

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Acute kidney injury after pediatric cardiac surgery

Yuan

2019

Pediatrics & Neonatology

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“…Prematurity may also result in a low nephron number, as discussed in greater detail below [49]. Multiple epidemiologic studies have identified associations of low birth weight with risk for renal disease, although a few have failed to identify such an effect [50–58]. …”

Section: Cellular Mechanisms Leading To Cakutmentioning

confidence: 99%

Renal development in the fetus and premature infant

Rosenblum

Pal

Reidy

2017

Seminars in Fetal and Neonatal Medicine

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SUMMARY Congenital abnormalities of the kidney and urinary tract (CAKUT) are one of the leading congenital defects to be identified on prenatal ultrasound. CAKUT represents a broad spectrum of abnormalities, from transient hydronephrosis to severe bilateral renal agenesis. CAKUT is a major contributor to chronic and end stage kidney disease (CKD/ESKD) in children. Both genetic abnormalities and the fetal environment contribute to CAKUT. Monogenic gene mutations identified in human CAKUT have advanced our understanding of molecular mechanisms of renal development. Low nephron number and solitary kidneys are associated with increased risk of adult onset CKD and ESKD. Premature and low birth weight infants represent a high risk population for low nephron number. Additional research is needed to identify modifiable factors to enhance nephron development in premature infants and biomarkers and appropriate follow-up of premature and low birth weight infants into adulthood.

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“…Phrenic nerve palsy has been rare following direct arch anastomosis. Jang et al (42) have described risk factors for acute kidney injury that they observed in 37% of their patients with 17% requiring peritoneal dialysis. They found lower body weight to be a risk factor.…”

Section: Advantages Of One Stage Primary Repair Direct Anastomosismentioning

confidence: 99%