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Pediatric Acute Kidney Injury: Focusing on Diagnosis and Management

  • Cho, Myung Hyun (Department of Pediatrics, Hallym University Sacred Heart Hospital)
  • Received : 2020.03.06
  • Accepted : 2020.04.09
  • Published : 2020.04.30

Abstract

Acute kidney injury (AKI) is common in critically ill children, and is associated with increased mortality and long-term renal sequelae. The definition of pediatric AKI was standardized based on elevation in serum creatinine levels or decrease in urine output; accordingly, epidemiological studies have ensued. Although new biomarkers appear to detect AKI earlier and predict prognosis more accurately than traditional markers, they are not frequently used in clinical setting. There is no validated pharmacological intervention for AKI, so prevention and early detection are the mainstays of treatment. For high risk or early stage AKI patients, optimization of volume status and blood pressure, avoidance of nephrotoxins, and sufficient nutritional support are necessary, and have been demonstrated to be effective in preventing the occurrence of AKI and improving prognosis. Nevertheless, renal replacement therapy is needed when conservative care fails.

Keywords

References

  1. Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med 2017;376:11-20. https://doi.org/10.1056/NEJMoa1611391
  2. Madsen NL, Goldstein SL, Froslev T, Christiansen CF, Olsen M. Cardiac surgery in patients with congenital heart disease is associated with acute kidney injury and the risk of chronic kidney disease. Kidney Int 2017;92:751-6. https://doi.org/10.1016/j.kint.2017.02.021
  3. Benisty K, Morgan C, Hessey E, Huynh L, Joffe AR, Garros D, et al. Kidney and blood pressure abnormalities 6 years after acute kidney injury in critically ill children: a prospective cohort study. Pediatr Res 2020.
  4. Kellum JA, Lameire N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 2013;17:204. https://doi.org/10.1186/cc11454
  5. Zappitelli M, Parikh CR, Akcan-Arikan A, Washburn KK, Moffett BS, Goldstein SL. Ascertainment and epidemiology of acute kidney injury varies with definition interpretation. Clin J Am Soc Nephrol 2008;3:948-54. https://doi.org/10.2215/CJN.05431207
  6. Charlton JR, Boohaker L, Askenazi D, Brophy PD, D'Angio C, Fuloria M, et al. Incidence and Risk Factors of Early Onset Neonatal AKI. Clin J Am Soc Nephrol 2019;14:184-95. https://doi.org/10.2215/CJN.03670318
  7. Jetton JG, Boohaker LJ, Sethi SK, Wazir S, Rohatgi S, Soranno DE, et al. Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health 2017;1:184-94. https://doi.org/10.1016/s2352-4642(17)30069-x
  8. Siegel SR, Oh W. Renal function as a marker of human fetal maturation. Acta Paediatr Scand 1976;65:481-5.
  9. Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Curr Opin Pediatr 2012;24:191-6. https://doi.org/10.1097/MOP.0b013e32834f62d5
  10. Bennett MR, Nehus E, Haffner C, Ma Q, Devarajan P. Pediatric reference ranges for acute kidney injury biomarkers. Pediatr Nephrol 2015;30:677-85. https://doi.org/10.1007/s00467-014-2989-y
  11. Devarajan P. Biomarkers for the early detection of acute kidney injury. Curr Opin Pediatr 2011;23:194-200. https://doi.org/10.1097/MOP.0b013e328343f4dd
  12. Beker BM, Corleto MG, Fieiras C, Musso CG. Novel acute kidney injury biomarkers: their characteristics, utility and concerns. Int Urol Nephrol 2018;50:705-13. https://doi.org/10.1007/s11255-017-1781-x
  13. Grubb A, Nyman U, Bjork J, Lindstrom V, Rippe B, Sterner G, et al. Simple cystatin C-based prediction equations for glomerular filtration rate compared with the modification of diet in renal disease prediction equation for adults and the Schwartz and the Counahan-Barratt prediction equations for children. Clin Chem 2005;51:1420-31. https://doi.org/10.1373/clinchem.2005.051557
  14. Hassinger AB, Backer CL, Lane JC, Haymond S, Wang D, Wald EL. Predictive power of serum cystatin C to detect acute kidney injury and pediatric-modified RIFLE class in children undergoing cardiac surgery. Pediatr Crit Care Med 2012;13:435-40. https://doi.org/10.1097/PCC.0b013e318238b43c
  15. Lau L, Al-Ismaili Z, Harel-Sterling M, Pizzi M, Caldwell JS, Piccioni M, et al. Serum cystatin C for acute kidney injury evaluation in children treated with aminoglycosides. Pediatr Nephrol 2017;32:163-71. https://doi.org/10.1007/s00467-016-3450-1
  16. El-Gammacy TM, Shinkar DM, Mohamed NR, Al-Halag AR. Serum cystatin C as an early predictor of acute kidney injury in preterm neonates with respiratory distress syndrome. Scand J Clin Lab Invest 2018;78:352-7. https://doi.org/10.1080/00365513.2018.1472803
  17. Benzer M, Alpay H, Baykan O, Erdem A, Demir IH. Serum NGAL, cystatin C and urinary NAG measurements for early diagnosis of contrast-induced nephropathy in children. Ren Fail 2016;38:27-34. https://doi.org/10.3109/0886022X.2015.1106846
  18. Cho MH, Kang HG. Acute kidney injury and continuous renal replacement therapy in children; what pediatricians need to know. Korean J Pediatr 2018;61:339-47. https://doi.org/10.3345/kjp.2018.06996
  19. Krawczeski CD, Goldstein SL, Woo JG, Wang Y, Piyaphanee N, Ma Q, et al. Temporal relationship and predictive value of urinary acute kidney injury biomarkers after pediatric cardiopulmonary bypass. J Am Coll Cardiol 2011;58:2301-9. https://doi.org/10.1016/j.jacc.2011.08.017
  20. Yoneyama F, Okamura T, Takigiku K, Yasukouchi S. Novel Urinary Biomarkers for Acute Kidney Injury and Prediction of Clinical Outcomes After Pediatric Cardiac Surgery. Pediatr Cardiol 2019.
  21. Bennett M, Dent CL, Ma Q, Dastrala S, Grenier F, Workman R, et al. Urine NGAL predicts severity of acute kidney injury after cardiac surgery: a prospective study. Clin J Am Soc Nephrol 2008;3:665-73. https://doi.org/10.2215/CJN.04010907
  22. Roy JP, Devarajan P. Acute Kidney Injury: Diagnosis and Management. Indian J Pediatr 2019.
  23. Hall PS, Mitchell ED, Smith AF, Cairns DA, Messenger M, Hutchinson M, et al. The future for diagnostic tests of acute kidney injury in critical care: evidence synthesis, care pathway analysis and research prioritisation. Health Technol Assess 2018;22:1-274.
  24. Westhoff JH, Tonshoff B, Waldherr S, Poschl J, Teufel U, Westhoff TH, et al. Urinary Tissue Inhibitor of Metalloproteinase-2 (TIMP-2) * Insulin-Like Growth Factor-Binding Protein 7 (IGFBP7) Predicts Adverse Outcome in Pediatric Acute Kidney Injury. PLoS One 2015;10:e0143628. https://doi.org/10.1371/journal.pone.0143628
  25. Chen J, Sun Y, Wang S, Dai X, Huang H, Bai Z, et al. The effectiveness of urinary TIMP-2 and IGFBP-7 in predicting acute kidney injury in critically ill neonates. Pediatr Res 2019.
  26. Selewski DT, Cornell TT, Heung M, Troost JP, Ehrmann BJ, Lombel RM, et al. Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population. Intensive Care Med 2014;40:1481-8. https://doi.org/10.1007/s00134-014-3391-8
  27. Alkandari O, Eddington KA, Hyder A, Gauvin F, Ducruet T, Gottesman R, et al. Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a twocenter retrospective cohort study. Crit Care 2011;15:R146. https://doi.org/10.1186/cc10269
  28. Askenazi DJ, Feig DI, Graham NM, Hui-Stickle S, Goldstein SL. 3-5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int 2006;69:184-9. https://doi.org/10.1038/sj.ki.5000032
  29. Mammen C, Al Abbas A, Skippen P, Nadel H, Levine D, Collet JP, et al. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis 2012;59:523-30. https://doi.org/10.1053/j.ajkd.2011.10.048
  30. Menon S, Kirkendall ES, Nguyen H, Goldstein SL. Acute kidney injury associated with high nephrotoxic medication exposure leads to chronic kidney disease after 6 months. J Pediatr 2014;165:522-7.e2. https://doi.org/10.1016/j.jpeds.2014.04.058
  31. Polito C, Papale MR, La Manna A. Long-term prognosis of acute renal failure in the full-term neonate. Clin Pediatr (Phila) 1998;37:381-5. https://doi.org/10.1177/000992289803700609
  32. Basu RK, Zappitelli M, Brunner L, Wang Y, Wong HR, Chawla LS, et al. Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children. Kidney Int 2014;85:659-67. https://doi.org/10.1038/ki.2013.349
  33. Kumar Sethi S, Agrawal G, Wazir S, Rohatgi S, Iyengar A, Chakraborty R, et al. Neonatal Acute Kidney Injury: A Survey of Perceptions and Management Strategies Amongst Pediatricians and Neonatologists. Front Pediatr 2019;7:553. https://doi.org/10.3389/fped.2019.00553
  34. Sutherland SM, Chawla LS, Kane-Gill SL, Hsu RK, Kramer AA, Goldstein SL, et al. Utilizing electronic health records to predict acute kidney injury risk and outcomes: workgroup statements from the 15(th) ADQI Consensus Conference. Can J Kidney Health Dis 2016;3:11. https://doi.org/10.1186/s40697-016-0099-4
  35. Park S, Baek SH, Ahn S, Lee KH, Hwang H, Ryu J, et al. Impact of Electronic Acute Kidney Injury (AKI) Alerts With Automated Nephrologist Consultation on Detection and Severity of AKI: A Quality Improvement Study. Am J Kidney Dis 2018;71:9-19. https://doi.org/10.1053/j.ajkd.2017.06.008
  36. Goldstein SL, Kirkendall E, Nguyen H, Schaffzin JK, Bucuvalas J, Bracke T, et al. Electronic health record identification of nephrotoxin exposure and associated acute kidney injury. Pediatrics 2013;132:e756-67. https://doi.org/10.1542/peds.2013-0794
  37. Chen H, Busse LW. Novel Therapies for Acute Kidney Injury. Kidney Int Rep 2017;2:785-99. https://doi.org/10.1016/j.ekir.2017.06.020
  38. Devarajan P. Acute Kidney Injury. In: Kliegman RM, ST Geme III JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, et al., editors. Nelson Textbook of Pediatrics. 21 ed. Philadelphia: Elsevier, 2019:2769-74.
  39. Claure-Del Granado R, Mehta RL. Fluid overload in the ICU: evaluation and management. BMC Nephrol 2016;17:109. https://doi.org/10.1186/s12882-016-0323-6
  40. Wang N, Jiang L, Zhu B, Wen Y, Xi XM. Fluid balance and mortality in critically ill patients with acute kidney injury: a multicenter prospective epidemiological study. Crit Care 2015;19:371. https://doi.org/10.1186/s13054-015-1085-4
  41. Sutherland SM, Zappitelli M, Alexander SR, Chua AN, Brophy PD, Bunchman TE, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis 2010;55:316-25. https://doi.org/10.1053/j.ajkd.2009.10.048
  42. Selewski DT, Goldstein SL. The role of fluid overload in the prediction of outcome in acute kidney injury. Pediatr Nephrol 2018;33:13-24. https://doi.org/10.1007/s00467-016-3539-6
  43. Moore PK, Hsu RK, Liu KD. Management of Acute Kidney Injury: Core Curriculum 2018. Am J Kidney Dis 2018;72:136-48. https://doi.org/10.1053/j.ajkd.2017.11.021
  44. Oh HW, Lee JH, Kim HC, Kim EH, Song IK, Kim HS, et al. The effect of 6% hydroxyethyl starch (130/0.4) on acute kidney injury in paediatric cardiac surgery: a prospective, randomised trial. Anaesthesia 2018;73:205-15. https://doi.org/10.1111/anae.14129
  45. Krajewski ML, Raghunathan K, Paluszkiewicz SM, Schermer CR, Shaw AD. Meta-analysis of high- versus low-chloride content in perioperative and critical care fluid resuscitation. Br J Surg 2015;102:24-36. https://doi.org/10.1002/bjs.9651
  46. Hoorn EJ. Intravenous fluids: balancing solutions. J Nephrol 2017;30:485-92. https://doi.org/10.1007/s40620-016-0363-9
  47. Langer T, Santini A, Scotti E, Van Regenmortel N, Malbrain ML, Caironi P. Intravenous balanced solutions: from physiology to clinical evidence. Anaesthesiol Intensive Ther 2015;47 Spec No:s78-88.
  48. Chowdhury AH, Cox EF, Francis ST, Lobo DN. A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and plasma-lyte(R) 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg 2012;256:18-24. https://doi.org/10.1097/SLA.0b013e318256be72
  49. Friederich A, Martin N, Swanson MB, Faine BA, Mohr NM. Normal Saline Solution and Lactated Ringer's Solution Have a Similar Effect on Quality of Recovery: A Randomized Controlled Trial. Ann Emerg Med 2019;73:160-9. https://doi.org/10.1016/j.annemergmed.2018.07.007
  50. Semler MW, Self WH, Wanderer JP, Ehrenfeld JM, Wang L, Byrne DW, et al. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med 2018;378:829-39. https://doi.org/10.1056/NEJMoa1711584
  51. Self WH, Semler MW, Wanderer JP, Wang L, Byrne DW, Collins SP, et al. Balanced Crystalloids versus Saline in Noncritically Ill Adults. N Engl J Med 2018;378:819-28. https://doi.org/10.1056/NEJMoa1711586
  52. Joannidis M, Druml W, Forni LG, Groeneveld ABJ, Honore PM, Hoste E, et al. Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017 : Expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine. Intensive Care Med 2017;43:730-49. https://doi.org/10.1007/s00134-017-4832-y
  53. Hui-Stickle S, Brewer ED, Goldstein SL. Pediatric ARF epidemiology at a tertiary care center from 1999 to 2001. Am J Kidney Dis 2005;45:96-101. https://doi.org/10.1053/j.ajkd.2004.09.028
  54. Cantais A, Hammouda Z, Mory O, Patural H, Stephan JL, Gulyaeva L, et al. Incidence of contrast-induced acute kidney injury in a pediatric setting: a cohort study. Pediatr Nephrol 2016;31:1355-62. https://doi.org/10.1007/s00467-016-3313-9
  55. Luk L, Steinman J, Newhouse JH. Intravenous Contrast-Induced Nephropathy-The Rise and Fall of a Threatening Idea. Adv Chronic Kidney Dis 2017;24:169-75. https://doi.org/10.1053/j.ackd.2017.03.001
  56. Sethi SK, Maxvold N, Bunchman T, Jha P, Kher V, Raina R. Nutritional management in the critically ill child with acute kidney injury: a review. Pediatr Nephrol 2017;32:589-601. https://doi.org/10.1007/s00467-016-3402-9
  57. Gordillo R, Ahluwalia T, Woroniecki R. Hyperglycemia and acute kidney injury in critically ill children. Int J Nephrol Renovasc Dis 2016;9:201-4. https://doi.org/10.2147/IJNRD.S115096
  58. Weisbord SD, Gallagher M, Jneid H, Garcia S, Cass A, Thwin SS, et al. Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. N Engl J Med 2018;378:603-14. https://doi.org/10.1056/NEJMoa1710933
  59. ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation 2011;124:1250-9. https://doi.org/10.1161/CIRCULATIONAHA.111.038943
  60. Bagshaw SM, Delaney A, Haase M, Ghali WA, Bellomo R. Loop diuretics in the management of acute renal failure: a systematic review and meta-analysis. Crit Care Resusc 2007;9:60-8.
  61. Karthik S, Lisbon A. Low-dose dopamine in the intensive care unit. Semin Dial 2006;19:465-71. https://doi.org/10.1111/j.1525-139X.2006.00208.x
  62. Bove T, Zangrillo A, Guarracino F, Alvaro G, Persi B, Maglioni E, et al. Effect of fenoldopam on use of renal replacement therapy among patients with acute kidney injury after cardiac surgery: a randomized clinical trial. Jama 2014;312:2244-53. https://doi.org/10.1001/jama.2014.13573
  63. Billings FTt, Hendricks PA, Schildcrout JS, Shi Y, Petracek MR, Byrne JG, et al. High-Dose Perioperative Atorvastatin and Acute Kidney Injury Following Cardiac Surgery: A Randomized Clinical Trial. Jama 2016;315:877-88. https://doi.org/10.1001/jama.2016.0548
  64. Sethi SK, Bunchman T, Raina R, Kher V. Unique considerations in renal replacement therapy in children: core curriculum 2014. Am J Kidney Dis 2014;63:329-45. https://doi.org/10.1053/j.ajkd.2013.08.018
  65. Pasin L, Boraso S, Tiberio I. Early initiation of renal replacement therapy in critically ill patients: a meta-analysis of randomized clinical trials. BMC Anesthesiol 2019;19:62. https://doi.org/10.1186/s12871-019-0733-7
  66. Sanchez-de-Toledo J, Perez-Ortiz A, Gil L, Baust T, Lines-Palazon M, Perez-Hoyos S, et al. Early Initiation of Renal Replacement Therapy in Pediatric Heart Surgery Is Associated with Lower Mortality. Pediatr Cardiol 2016;37:623-8. https://doi.org/10.1007/s00246-015-1323-1
  67. Kwiatkowski DM, Sutherland SM. Acute kidney injury in pediatric patients. Best Pract Res Clin Anaesthesiol 2017;31:427-39. https://doi.org/10.1016/j.bpa.2017.08.007
  68. Nash DM, Przech S, Wald R, O'Reilly D. Systematic review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit. J Crit Care 2017;41:138-44. https://doi.org/10.1016/j.jcrc.2017.05.002
  69. de Galasso L, Picca S, Guzzo I. Dialysis modalities for the management of pediatric acute kidney injury. Pediatr Nephrol 2019.
  70. Ronco C, Garzotto F, Ricci Z. CA.R.PE.DI.E.M. (Cardio-Renal Pediatric Dialysis Emergency Machine): evolution of continuous renal replacement therapies in infants. A personal journey. Pediatr Nephrol 2012;27:1203-11. https://doi.org/10.1007/s00467-012-2179-8
  71. Coulthard MG, Crosier J, Griffiths C, Smith J, Drinnan M, Whitaker M, et al. Haemodialysing babies weighing <8 kg with the Newcastle infant dialysis and ultrafiltration system (Nidus): comparison with peritoneal and conventional haemodialysis. Pediatr Nephrol 2014;29:1873-81. https://doi.org/10.1007/s00467-014-2923-3