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Updated: Dec 11, 2025
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Acute renal failure in children. Multicenter prospective cohort study in medium-complexity intensive care units from
Jaime M Restrepo1, Mónica V Mondragon2, Jessica M Forero-Delgadillo1
1Department of Pediatric Nephrology, Fundación Valle del Lili, Cali, Colombia.
Insights
Acute kidney injury (AKI) in critically ill children is common. Severe AKI, particularly stage 3, significantly worsens outcomes, increasing pediatric intensive care unit stays and mortality, highlighting the need for early intervention.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Epidemiology
Background:
- Acute kidney injury (AKI) is a frequent complication in critically ill children, with varying causes and epidemiology based on care complexity.
- This study investigated the clinical prognosis of pediatric patients diagnosed with AKI in medium-complexity pediatric intensive care units (PICUs).
Purpose of the Study:
- To estimate the clinical prognosis of children diagnosed with acute kidney injury.
- To analyze the association between the severity of AKI, classified by KDIGO stages, and clinical outcomes in critically ill children.
Main Methods:
- A multicenter prospective cohort study included children aged >28 days to <18 years diagnosed with AKI.
- AKI was classified using Kidney Disease Improving Global Outcomes (KDIGO) criteria; severe AKI was defined as KDIGO stage 2 or 3.
- Outcomes assessed included length of hospital stay, mechanical ventilation, vasoactive drug use, renal replacement therapy, and mortality.
Main Results:
- The prevalence of AKI at admission was 5.2%.
- Increased maximum KDIGO stage correlated with longer PICU stays and greater need for mechanical ventilation.
- Mortality was 11.8%, with severe AKI (KDIGO 3) associated with higher rates of renal replacement therapy.
Conclusions:
- Established and severe acute kidney injury, as defined by KDIGO, is linked to adverse clinical outcomes in critically ill children.
- Early therapeutic interventions are crucial to prevent the progression of AKI to severe stages and improve patient prognosis.
Background:
Acute kidney injury is frequent in critically ill children; however, it varies in causality and epidemiology according to the level of patient care complexity. A multicenter prospective cohort study was conducted in four medium-complexity pediatric intensive care units from the Colombian southeast aimed to estimate the clinical prognosis of patients with diagnosis of acute kidney injury.
Methods:
We included children >28 days and <18 years of age, who were admitted with diagnosis of acute kidney injury classified by Kidney Disease Improving Global Outcomes (KDIGO), during the period from January to December 2017. Severe acute kidney injury was defined as stage 2 and stage 3 classifications. Maximum KDIGO was evaluated during the hospital stay and follow up. Length of hospital stay, use of mechanical ventilation and vasoactive drugs, use of renal replacement therapy, and mortality were assessed until discharge.
Results:
Prevalence at admission of acute kidney injury was 5.2% (95%CI 4.3% to 6.2%). It was found that 71% of the patients had their maximum KDIGO on day one; an increment in the maximum stage of acute kidney injury increased the pediatric intensive care unit stay. Patients with maximum KDIGO 3 were associated with greater use of mechanical ventilation (47%), compared with maximum KDIGO 2 (37%) and maximum KDIGO 1 (16%). Eight patients with maximum KDIGO 2 and 14 with maximum KDIGO 3 required renal replacement therapy. Mortality was at 11.8% (95%CI 6.4% to 19.4%).
Conclusion:
Acute kidney injury, established and classified according to KDIGO as severe and its maximum stage, was associated with worse clinical outcomes; early therapeutic efforts should focus on preventing the progression to severe stages.
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