Early detection of acute kidney injury after pediatric cardiac surgery

Abstract

Acute kidney injury (AKI) is increasingly recognized as a common problem in children undergoing cardiac surgery, with well documented increases in morbidity and mortality in both the short and the long term. Traditional approaches to the identification of AKI such as changes in serum creatinine have revealed a large incidence in this population with significant negative impact on clinical outcomes. However, the traditional diagnostic approaches to AKI diagnosis have inherent limitations that may lead to under-diagnosis of this pathologic process. There is a dearth of randomized controlled trials for the prevention and treatment of AKI associated with cardiac surgery, at least in part due to the paucity of early predictive biomarkers. Novel non-invasive biomarkers have ushered in a new era that allows for earlier detection of AKI. With these new diagnostic tools, a more consistent approach can be employed across centers that may facilitate a more accurate representation of the actual prevalence of AKI and more importantly, clinical investigation that may minimize the occurrence of AKI following pediatric cardiac surgery. A thoughtful management approach is necessary to mitigate the effects of AKI after cardiac surgery, which is best accomplished in close collaboration with pediatric nephrologists. Long-term surveillance for improvement in kidney function and potential development of chronic kidney disease should also be a part of the comprehensive management strategy.

Keywords: Acute kidney injury; Acute renal failure; Biomarkers; Cardiac surgery; Children; Congenital heart surgery.

Fig. 1

Profiles of tubular injury biomarker concentrations at various time points after cardiopulmonary bypass (CPB) initiation. Data are from Krawczeski et al. [69]. Urinary biomarker concentrations are shown for NGAL (ng/ml), IL-18 (pg/ml), L-FABP (ng/ml), and KIM-1 (pg/0.1 ml).