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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Management of Acute Kidney Injury in Critically Ill Children
Sudarsan Krishnasamy1, Aditi Sinha2, Arvind Bagga3
1Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Insights
Acute kidney injury (AKI) is common in critically ill children and neonates. Early detection and management of AKI are crucial for reducing mortality and long-term complications.
Area of Science:
- Nephrology
- Pediatric Critical Care
- Intensive Care Medicine
Background:
- Acute kidney injury (AKI) affects a significant proportion of critically ill children and neonates, with higher stages correlating to poorer outcomes.
- AKI is an independent predictor of mortality in critically ill patients.
- Timely identification and management of AKI are essential for improving patient survival and reducing long-term sequelae.
Purpose of the Study:
- To emphasize the importance of early AKI detection and management in critically ill pediatric populations.
- To highlight strategies for preventing and treating severe AKI.
- To underscore the need for long-term follow-up for patients with AKI.
Main Methods:
- Review of current literature and clinical guidelines regarding AKI in critically ill children and neonates.
- Discussion of predictive methods for severe AKI.
- Emphasis on volume status assessment and fluid overload prevention.
- Consideration of kidney replacement therapy (KRT) modalities and indications.
- Recommendation for long-term follow-up protocols.
Main Results:
- AKI is prevalent in critically ill children (nearly 1 in 4) and neonates (1 in 3).
- Higher AKI stages are associated with increased mortality.
- Fluid overload prevention and prompt KRT are critical interventions.
- Long-term follow-up is necessary due to the risk of chronic kidney disease.
Conclusions:
- Improving awareness, prevention, and management of AKI in critically ill children and neonates is vital.
- Integrating AKI prevention into quality initiatives can reduce morbidity and mortality.
- Standardized protocols for AKI detection, treatment, and follow-up are needed to improve outcomes.
Abstract:
Acute kidney injury (AKI) is common in critically ill patients, affecting almost one in four critically ill children and one in three neonates. Higher stages of AKI portend worse outcomes. Identifying AKI timely and instituting appropriate measures to prevent and manage severe AKI is important, since it is independently associated with mortality. Methods to predict severe AKI should be applied to all critically ill patients. Assessment of volume status to prevent the development of fluid overload is useful to prevent adverse outcomes. Patients with metabolic or clinical complications of AKI need prompt kidney replacement therapy (KRT). Various modes of KRT are available, and the choice of modality depends most on the technical competence of the center, patient size, and hemodynamic stability. Given the significant risk of chronic kidney disease, patients with AKI require long-term follow-up. It is important to focus on improving awareness about AKI, incorporate AKI prevention as a quality initiative, and improve detection, prevention, and management of AKI with the aim of reducing acute and long-term morbidity and mortality.
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