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Pediatric acute kidney injury: new advances in the last decade
( Sidharth K. Sethi ),( Timothy Bunchman ),( Ronith Chakraborty ),( Rupesh Raina ) 대한신장학회 2021 Kidney Research and Clinical Practice Vol.40 No.1
Pediatric acute kidney injury (AKI) is a frequently missed complication. AKI has a significant impact on both short- and long-term out comes in children. Within the last decade, there have been major landmark developments in this field of critical care pediatric ne phrology. The topic was searched by two independent researchers using Google Scholar and PubMed and related studies published in the last 10 years. The terms used for the search were ‘pediatric acute kidney injury,’ ‘pediatric acute renal failure,’ ‘pediatric dialy sis,’ ‘biomarkers,’ ‘nephrotoxins,’ ‘nephrotoxicity in children,’ and ‘pediatric critical care nephrology.’ We found that AKI is common in critically ill neonates and children. Among the various definitions, the Kidney Disease: Improving Global Outcomes (KDIGO) definition is most commonly used. In addition, it is imperative to risk stratify sick children at admission in the hospital to predict AKI and worse outcomes as this aids in early management. There are now major landmark trials that describe the epidemiology, prevention, and management guidelines in this field and health care professionals need to be aware they should diagnose AKI early. Overall, this re view highlights the landmark studies in the last decade and shows that early diagnosis and management of AKI in ‘at risk’ children can improve outcomes.
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Development of acute kidney injury following pediatric cardiac surgery
Aditya Sharma,Ronith Chakraborty,Katyayini Sharma,Sidharth K. Sethi,Rupesh Raina 대한신장학회 2020 Kidney Research and Clinical Practice Vol.39 No.3
Acute kidney injury (AKI) in the pediatric population is a relatively common phenomenon. Specifically, AKI has been found in increasing numbers within the pediatric population following cardiac surgery, with up to 43% of pediatric patients developing AKI post-cardiac surgery. However, recent advances have allowed for the identification of risk factors. These can be divided into preoperative, intraoperative, and postoperative factors. Although the majority of pediatric patients developing AKI after cardiac surgery completely recover, this condition is associated with worse outcomes. These include fluid overload and increased mortality and result in longer hospital and intensive care unit stays. Detecting the presence of AKI has advanced; use of relatively novel biomarkers, including neutrophil gelatinase associated lipocalin, has shown promise in detecting more subtle changes in kidney function when compared to conventional methods. While a single, superior treatment has not been elucidated yet, novel functions of medications, including fenoldopam, theophylline and aminophylline, have been shown to have better outcomes for these patients. With the recent advances in identification of risk factors, outcomes, diagnosis, and management, the medical community can further explain the complexities of AKI in the pediatric population post-cardiac surgery
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