Recognition and Reporting of AKI in Very Low Birth Weight Infants

Carmody, John; Swanson, Jonathan R.; Rhone, Erika T.; Charlton, Jennifer R.

doi:10.2215/cjn.05190514

Cited by 213 publications

(177 citation statements)

References 51 publications

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“…Here, we report a much higher incidence of AKI of 50.9%, which likely reflects several factors. First, mild degrees of AKI are commonly overlooked and not recorded on the discharge summary (18,19). Second, we used a standardized definition of AKI, which undoubtedly led to increased recognition of AKI.…”

Section: Discussionmentioning

confidence: 99%

AKI in Children Hospitalized with Nephrotic Syndrome

Rheault¹,

Zhang²,

Selewski³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Children with nephrotic syndrome can develop life-threatening complications, including infection and thrombosis. While AKI is associated with adverse outcomes in hospitalized children, little is known about the epidemiology of AKI in children with nephrotic syndrome. The main objectives of this study were to determine the incidence, epidemiology, and hospital outcomes associated with AKI in a modern cohort of children hospitalized with nephrotic syndrome.Design, setting, participants, & measurements Records of children with nephrotic syndrome admitted to 17 pediatric nephrology centers across North America from 2010 to 2012 were reviewed. AKI was classified using the pediatric RIFLE definition.Results AKI occurred in 58.6% of 336 children and 50.9% of 615 hospitalizations (27.3% in stage R, 17.2% in stage I, and 6.3% in stage F). After adjustment for race, sex, age at admission, and clinical diagnosis, infection (odds ratio, 2.24; 95% confidence interval, 1.37 to 3.65; P=0.001), nephrotoxic medication exposure (odds ratio, 1.35; 95% confidence interval, 1.11 to 1.64; P=0.002), days of nephrotoxic medication exposure (odds ratio, 1.10; 95% confidence interval, 1.05 to 1.15; P,0.001), and intensity of medication exposure (odds ratio, 1.34; 95% confidence interval, 1.09 to 1.65; P=0.01) remained significantly associated with AKI in children with nephrotic syndrome. Nephrotoxic medication exposure was common in this population, and each additional nephrotoxic medication received during a hospitalization was associated with 38% higher risk of AKI. AKI was associated with longer hospital stay after adjustment for race, sex, age at admission, clinical diagnosis, and infection (difference, 0.45 [log]days; 95% confidence interval, 0.36 to 0.53 [log]days; P,0.001).Conclusions AKI is common in children hospitalized with nephrotic syndrome and should be deemed the third major complication of nephrotic syndrome in children in addition to infection and venous thromboembolism. Risk factors for AKI include steroid-resistant nephrotic syndrome, infection, and nephrotoxic medication exposure. Children with AKI have longer hospital lengths of stay and increased need for intensive care unit admission.

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Section: Discussionmentioning

confidence: 99%

AKI in Children Hospitalized with Nephrotic Syndrome

Rheault¹,

Zhang²,

Selewski³

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…10,65,66 In 2011, Koralkar et al 10 reported on 229 VLBW infants followed prospectively from birth until 36 weeks postmenstrual age. The incidence of AKI, by using the neonatal modified KDIGO criteria, was 18%.…”

Section: Vlbw and Elbw Neonatesmentioning

confidence: 99%

Neonatal Acute Kidney Injury

et al. 2015

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In recent years, there have been significant advancements in our understanding of acute kidney injury (AKI) and its impact on outcomes across medicine. Research based on single-center cohorts suggests that neonatal AKI is very common and associated with poor outcomes. In this state-of-the-art review on neonatal AKI, we highlight the unique aspects of neonatal renal physiology, definition, risk factors, epidemiology, outcomes, evaluation, and management of AKI in neonates. The changes in renal function with gestational and chronologic age are described. We put forth and describe the neonatal modified Kidney Diseases: Improving Global Outcomes AKI criteria and provide the rationale for its use as the standardized definition of neonatal AKI. We discuss risk factors for neonatal AKI and suggest which patient populations may warrant closer surveillance, including neonates ,1500 g, infants who experience perinatal asphyxia, near term/ term infants with low Apgar scores, those treated with extracorporeal membrane oxygenation, and those requiring cardiac surgery. We provide recommendations for the evaluation and treatment of these patients, including medications and renal replacement therapies. We discuss the need for long-term follow-up of neonates with AKI to identify those children who will go on to develop chronic kidney disease. This review highlights the deficits in our understanding of neonatal AKI that require further investigation. In an effort to begin to address these needs, the Neonatal Kidney Collaborative was formed in 2014 with the goal of better understanding neonatal AKI, beginning to answer critical questions, and improving outcomes in these vulnerable populations.

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“…The risk of neonatal AKI increases with increasing degree of prematurity, demonstrating a dose-response effect in the susceptibility of the developing kidney to injury [159]. Neonatal AKI is associated with poor short-term outcomes, such as increased mortality and longer hospital stays [159,160].…”

Section: Introduction To a Health Problemmentioning

confidence: 99%

“…Neonatal AKI is associated with poor short-term outcomes, such as increased mortality and longer hospital stays [159,160]. In addition to the association between neonatal AKI and short-term outcomes, AKI is linked to the development of CKD both in epidemiology studies and in studies of LBW subjects (weighing <1.5 or 1.0 kg), an effect that may be modulated by the development of obesity [20,161,162,163,164].…”

Section: Introduction To a Health Problemmentioning

confidence: 99%

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

Brenner

Charlton

Luyckx

et al. 2017

Nephron

119

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Hypertension and chronic kidney disease (CKD) have a significant impact on global morbidity and mortality. The Low Birth Weight and Nephron Number Working Group has prepared a consensus document aimed to address the relatively neglected issue for the developmental programming of hypertension and CKD. It emerged from a workshop held on April 2, 2016, including eminent internationally recognized experts in the field of obstetrics, neonatology, and nephrology. Through multidisciplinary engagement, the goal of the workshop was to highlight the association between fetal and childhood development and an increased risk of adult diseases, focusing on hypertension and CKD, and to suggest possible practical solutions for the future. The recommendations for action of the consensus workshop are the results of combined clinical experience, shared research expertise, and a review of the literature. They highlight the need to act early to prevent CKD and other related noncommunicable diseases later in life by reducing low birth weight, small for gestational age, prematurity, and low nephron numbers at birth through coordinated interventions. Meeting the current unmet needs would help to define the most cost-effective strategies and to optimize interventions to limit or interrupt the developmental programming cycle of CKD later in life, especially in the poorest part of the world.

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Recognition and Reporting of AKI in Very Low Birth Weight Infants

Cited by 213 publications

References 51 publications

AKI in Children Hospitalized with Nephrotic Syndrome

AKI in Children Hospitalized with Nephrotic Syndrome

Neonatal Acute Kidney Injury

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

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