Acute Kidney Injury in Children| Stephy Publishers

 


SOJ Pediatrics and Clinical Neonatology - (SOJPCN)| Stephy Publishers


Abstract
Recent literature data has shown that acute kidney injury (AKI) is a common occurrence in critically ill children and that it is associated with high rates of morbidity and mortality, even after adjusting for other risk factors. In addition, it can result in long-term sequelae translated by the development of arterial hypertension, microalbuminuria and chronic renal dysfunction. High degree of suspicion, early diagnosis based on the recognition of patients at risk and the use of new criteria for the diagnosis and classification of AKI and, whenever possible, using the new biomarkers can positively alter the prognosis of these patients. Although there is still no specific treatment for AKI, it is recommended to focus on the immediate institution of preventive measures in order to maintain renal hemodynamics, early treatment of septic patients, elimination of exogenous nephrotoxins, recognition and management of patients with AKI secondary to high levels of endotoxins, control and normalization of volume after the initial phase of fluid resuscitation, sufficient nutritional support, and recognition and treatment of the underlying causes are necessary. Patients that fail with conservative care will need renal replacement therapy.

Keywords: Acute kidney injury, Nephrotoxicity, Hemoglobinuria, Endotoxins

 

Introduction

AKI commonly occurs in critically ill children, and its incidence has increased globally in recent years. Evidence demonstrates a significant association between AKI and morbidity and mortality in the acute phase and an association with long-term nephrological sequelae.1  For the past 15 years, advances in research on AKI have allowed us to recognize that even small renal function changes, previously considered insignificant, may negatively impact. Shortterm impact on length of stay and mortality and development of long-term renal dysfunction with microalbuminuria, proteinuria, arterial hypertension and impaired renal function.1  Mortality rates remain relatively high and range from 10% uncomplicated cases to 80% complicated cases requiring renal replacement therapy.2,3 In epidemiological terms, the prospective observational “AWARE” study, carried out in 2014, including children aged 3 to 25 years admitted to 32 intensive care units (ICU) in Asia, Australia, Europe, and North America, demonstrated a global incidence of 26.9% AKI among 4,683 children, 11.6% were considered with severe AKI (KDIGO 2 or 3). Patients with severe AKI had an odds ratio adjusted for mortality of 1.77 (CI 1.17-2.68) and a mortality rate of 11% versus 2.5% (p <0.001) for patients without severe AKI.4 Since the kidney is the central mediator of host homeostasis, the aberrant renal function will impact systemic health. Recent findings in the literature demonstrate that in addition to the obvious consequences associated with AKI, such as slag accumulation, hydro electrolytic, and acid-base disorders, some other effects are less apparent.


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