Update on prognosis driven classification of pediatric AKI

Abstract

Acute kidney injury (AKI) affects a large proportion of hospitalized children and increases morbidity and mortality in this population. Initially thought to be a self-limiting condition with uniformly good prognosis, we now know that AKI can persist and progress to acute kidney disease (AKD) and chronic kidney disease (CKD). AKI is presently categorized by stage of injury defined by increase in creatinine, decrease in eGFR, or decrease in urine output. These commonly used biomarkers of acute kidney injury do not change until the injury is well established and are unable to detect early stage of the disease when intervention is likely to reverse injury. The kidneys have the ability to compensate and return serum creatinine to a normal or baseline level despite nephron loss in the setting of AKI possibly masking persistent dysfunction. Though these definitions are important, classifying children by their propensity for progression to AKD and CKD and defining these risk strata by other factors besides creatinine may allow for better prognosis driven discussion, expectation setting, and care for our patients. In order to develop a classification strategy, we must first be able to recognize children who are at risk for AKD and CKD based on modifiable and non-modifiable factors as well as early biomarkers that identify their risk of persistent injury. Prevention of initial injury, prompt evaluation and treatment if injury occurs, and mitigating further injury during the recovery period may be important factors in decreasing risk of AKD and CKD after AKI. This review will cover presently used definitions of AKI, AKD, and CKD, recent findings in epidemiology and risk factors for AKI to AKD to CKD progression, novel biomarkers for early identification of AKI and AKI that may progress to CKD and future directions for improving outcome in children with AKI.

Sophocarpine Alleviates Isoproterenol-Induced Kidney Injury by Suppressing Inflammation, Apoptosis, Oxidative Stress and Fibrosis

“…The deterioration of renal function characterizes kidney injury, which is often associated with a significant increase in serum creatinine (SCr) and blood urea nitrogen (BUN) levels, as well as a persistent decrease in the glomerular filtration rate (GFR) [1]. The course of this disease is temporary, but in the long term, kidney dysfunction is irreversible [2]. There has been a progressive increase in morbidity and mortality due to kidney injury, with nearly 2 million deaths occurring every year worldwide, contributing to a serious medical security issue [3].…”

Insuficiência renal aguda: experiência de um centro terciário de Nefrologia Pediátrica

“…Atualmente, as etiologias pré-renais são as mais comumente associadas à IRA pediátrica, seguidas por distúrbios intrínsecos ou renais, como a glomerulonefrite 14,17,18 . Uma vez que poucas abordagens terapêuticas específicas e eficazes estão disponíveis no momento, o conhecimento dos fatores de risco para IRA é de suma importância 1,19,20 . Fatores como prematuridade ou comorbidades crônicas e eventos como depleção de volume, exposição a nefrotoxinas, sepse e cirurgias de grande porte (cirurgias cardíacas, principalmente com circulação extracorpórea) são os fatores preponderantes para o desenvolvimento de IRA 1,2,5 .…”

Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology

“…Pre-renal etiologies are currently the most commonly associated with pediatric AKI, followed by intrinsic or renal disorders, such as glomerulonephritis 14,17,18 . Since few effective specific therapeutic approaches are available today, knowledge of the risk factors for AKI is of paramount importance 1,19,20 . Factors like prematurity or chronic comorbidities and events such as volume depletion, nephrotoxin exposure, sepsis, and major surgery (cardiac surgery, mainly with cardiopulmonary bypass) are the preponderant factors for the development of AKI 1,2,5 .…”