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Acute kidney injury in congenital heart disease
Katja M Gist1, David M Kwiatkowski2, David S Cooper3
1The Heart Institute, Children's Hospital of Colorado, University of Colorado, Aurora, Colorado.
Insights
Acute kidney injury (AKI) in children with heart conditions poses risks. Novel biomarkers aid early detection and intervention, challenging the notion of full renal recovery post-AKI.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) significantly increases morbidity and mortality in pediatric patients with congenital heart disease (CHD) and congestive heart failure (CHF).
- Understanding AKI's impact is crucial for managing these vulnerable patient populations.
Purpose of the Study:
- To review the definition, manifestations, and diagnostic advancements in AKI.
- To highlight the role of fluid overload and its long-term consequences.
- To discuss novel biomarkers for early AKI detection and intervention.
Main Methods:
- Comprehensive literature review of studies on AKI in pediatric cardiac patients.
- Analysis of current diagnostic criteria and emerging biomarkers.
- Evaluation of the impact of fluid overload and renal recovery.
Main Results:
- AKI presents with diverse clinical manifestations.
- Biomarkers are improving the diagnosis of AKI.
- Fluid overload is a significant consequence of AKI with lasting effects.
Conclusions:
- Novel biomarkers enable earlier AKI recognition and intervention, mitigating AKI and fluid overload effects.
- The assumption of complete renal function recovery in AKI survivors is inaccurate.
- Early detection and management are key to improving outcomes in pediatric AKI.
Purpose Of Review:
Acute kidney injury (AKI) is associated with significant morbidity and mortality in patients with congenital heart disease undergoing cardiac surgery or in pediatric patients with congestive heart failure.
Recent Findings:
This review describes the definition and various manifestations of AKI, the impact of biomarkers on the diagnosis of AKI, the importance of fluid overload as a consequence of AKI and its long-term impact.
Summary:
There are novel biomarkers for AKI detection that should facilitate early recognition and intervention to prevent or attenuate the effects of AKI and fluid overload. Previous conventional wisdom that survivors of AKI fully recover renal function without subsequent consequences is flawed.