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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
PROGRESSION OF CHRONIC KIDNEY DISEASE AFTER ACUTE KIDNEY INJURY
Prasad Devarajan1, John Lynn Jefferies2
1Division of Nephrology and Hypertension.
Insights
Chronic kidney disease (CKD) is rising in children and adults, particularly those with congenital heart disease. Understanding the link between acute kidney injury (AKI) and CKD is crucial for better patient outcomes.
Area of Science:
- Nephrology
- Cardiology
- Pediatrics
Background:
- Increasing incidence of chronic kidney disease (CKD) in pediatric and adult populations.
- High comorbidity of CKD in patients with congenital heart disease (CHD), estimated at 30-50%.
- Acute kidney injury (AKI) following cardiac dysfunction or surgery frequently progresses to CKD.
Purpose of the Study:
- To review definitions, epidemiology, and complications of pediatric CKD, especially in those with CHD.
- To examine the progression of CKD post-AKI in pediatric cardiac patients.
- To explore novel biomarkers for predicting CKD progression.
Main Methods:
- Literature review of current definitions and epidemiology of pediatric CKD.
- Analysis of clinical and experimental evidence on AKI-to-CKD progression in pediatric cardiac disease.
- Discussion of the role of biomarkers in CKD progression.
Main Results:
- CKD and AKI are interconnected syndromes with significant long-term cardiovascular consequences.
- Pediatric patients with both CHD and CKD face compounded medical, financial, and quality-of-life challenges.
- Early diagnosis and preventive strategies are essential for managing CKD in this population.
Conclusions:
- Improved understanding of CKD epidemiology, mechanisms, and biomarkers is vital for cardiologists, nephrologists, and policymakers.
- Interdisciplinary collaboration is necessary to address the growing burden of CKD in children, particularly those with heart conditions.
- Further research into novel biomarkers can aid in predicting and preventing CKD progression.
Abstract:
The incidence of chronic kidney disease (CKD) in children and adults is increasing. Cardiologists have become indispensable members of the care provider team for children with CKD. This is partly due to the high incidence of CKD in children and adults with congenital heart disease, with current estimates of 30-50%. In addition, the high incidence of acute kidney injury (AKI) due to cardiac dysfunction or following pediatric cardiac surgery that may progress to CKD is also well documented. It is now apparent that AKI and CKD are uniquely intertwined as interconnected syndromes. Furthermore, the well-known long-term cardiovascular morbidity and mortality associated with CKD require the joint attention of both nephrologists and cardiologists. Children with both congenital heart disease and CKD are increasingly surviving to adulthood, with synergistically negative medical, financial, and quality of life impact. An improved understanding of the epidemiology, mechanisms, early diagnosis, and preventive measures is of importance to cardiologists, nephrologists, scientists, economists, and policy makers alike. Herein, we report the current definitions, epidemiology, and complications of CKD in children, with an emphasis on children with congenital heart disease. We then focus on the clinical and experimental evidence for the progression of CKD after episodes of AKI commonly encountered in children with heart disease, and explore the role of novel biomarkers for the prediction of CKD progression.
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