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Is acute kidney injury a harbinger for chronic kidney disease?
David T Selewski1, Dylan M Hyatt2, Kevin M Bennett3
1Department of Pediatrics & Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan.
Insights
Acute kidney injury (AKI) is common in critically ill children and may lead to chronic kidney disease (CKD). Further research and better biomarkers are needed to understand this pediatric kidney disease link.
Area of Science:
- Pediatric Nephrology
- Renal Medicine
- Critical Care
Background:
- Acute kidney injury (AKI) is prevalent in critically ill children and neonates.
- AKI is independently linked to adverse health outcomes in pediatric patients.
- Identifying high-risk pediatric populations for AKI is crucial.
Purpose of the Study:
- To review the relationship between AKI and chronic kidney disease (CKD) in pediatric populations.
- To examine long-term renal health effects of AKI in children.
- To explore biomarkers for early detection of renal disease.
Main Methods:
- Review of existing literature on pediatric AKI and CKD.
- Identification of high-risk pediatric groups for AKI.
- Evaluation of current and emerging biomarkers for renal disease detection.
Main Results:
- Pediatric AKI is common, particularly in neonates and critically ill children.
- High-risk groups include neonates with necrotizing enterocolitis, and children with diabetes or sickle cell disease.
- Preterm birth and AKI in neonates are associated with early childhood renal dysfunction.
- Urinary biomarkers show promise for earlier AKI and CKD detection, but require further validation.
- Technological advancements may aid in characterizing the AKI to CKD transition.
Conclusions:
- Acute kidney injury (AKI) is likely a precursor to chronic kidney disease (CKD) in pediatric patients.
- Definitive answers regarding the AKI-CKD link in children are currently lacking.
- More research is essential to establish causality and improve diagnostic tools.
Purpose Of Review:
Despite abundant evidence in adults, the relationship between acute kidney injury (AKI) and chronic kidney disease (CKD) remains unanswered in pediatrics. Obstacles to overcome include the challenges defining these entities and the lack of long-term follow-up studies. This review focuses on pediatric populations at high-risk for AKI, the evidence of the long-term effect of AKI on renal health, and biomarkers to detect renal disease.
Recent Findings:
AKI in critically ill children and neonates is common and independently associated with adverse outcomes. Patients with diabetes and sickle cell disease along with neonates with necrotizing enterocolitis have been identified as high-risk for AKI. Preterm birth and neonates with AKI have signs of renal dysfunction early in childhood. Urinary biomarkers may identify AKI and CKD earlier than traditional biomarkers, but more work is necessary to determine their clinical utility. Promising technological advances including the ability to determine nephron number noninvasively will expand our ability to characterize the AKI to CKD transition.
Summary:
AKI is common and associated with poor outcomes. It is probable that AKI is a harbinger to CKD in pediatric populations. However, we currently lack the tools to definitely answer this question and more research is needed.
Related Concept Videos
01:22Acute Kidney Injury I: Introduction
01:29Acute Kidney Injury II: Pathophysiology
01:25Chronic Kidney Disease I: Introduction
01:22Acute Kidney Injury VI: Nursing Management
01:20Acute Kidney Injury V: Interprofessional Care
01:24Chronic Kidney Disease II: Clinical Manifestations