Pediatric acute kidney injury: new advances in the last decade

Abstract

Pediatric acute kidney injury (AKI) is a frequently missed complication. AKI has a significant impact on both short- and long-term outcomes in children. Within the last decade, there have been major landmark developments in this field of critical care pediatric nephrology. 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 dialysis,' '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 review highlights the landmark studies in the last decade and shows that early diagnosis and management of AKI in 'at risk' children can improve outcomes.

Keywords: Acute kidney injury; Biomarkers; Critical care; Dialysis.

Figure. 1.. Timeline of landmark studies in pediatric acute kidney injury (AKI).

AKIN, Acute Kidney Injury Network; AWAKEN, Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates; AWARE, Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology; CARPEDIEM, CARdiorenal PEDIatric Emergency Machine; KDIGO, Kidney Disease: Improving Global Outcomes; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; NIDUS, Newcastle Infant Dialysis and Ultrafiltration System; NINJA, Nephrotoxic Injury Negated by Just-in-time Action; NKC, Neonatal Kidney Collaborative; PCRRT, Pediatric Continuous Renal Replacement Therapy; pRIFLE, pediatric Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease; SLED, sustained low-efficiency dialysis; SLED-F, sustained low-efficiency diafiltration.