Acute kidney injury after pediatric cardiac surgery

Abstract

Acute kidney injury (AKI) is a common complication of pediatric cardiac surgery and is associated with increased morbidity and mortality. Literature of AKI after pediatric cardiac surgery is comprehensively reviewed in terms of incidence, risk factors, biomarkers, treatment and prognosis. The novel RIFLE (pediatric RIFLE for pediatrics), Acute Kidney Injury Network (AKIN) and Kidney Disease Improving Global Outcomes (KDIGO) criteria have brought about unified diagnostic standards and comparable results for AKI after cardiac surgery. Numerous risk factors, either renal or extrarenal, can be responsible for the development of AKI after cardiac surgery, with low cardiac output syndrome being the most pronounced predictor. Early fluid overload is also crucial for the occurrence of AKI and prognosis in pediatric patients. Three sensitive biomarkers, neutrophil gelatinase-associated lipocalin, cystatin C (CysC) and liver fatty acid-binding protein, are regarded as the earliest (increase at 2-4 h), and another two, kidney injury molecule-1 and interleukin-18 represent the intermediate respondents (increase at 6-12 h after surgery). To ameliorate the cardiopulmonary bypass techniques, improve renal perfusion and eradicate the causative risk factors are imperative for the prevention of AKI in pediatric patients. The early and intermediate biomarkers are helpful for an early judgment of occurrence of postoperative AKI. Improved survival has been achieved by prevention, renal support and modifications of hemofiltration techniques. Further development is anticipated in small children.

Acute Kidney Injury Associated with Cardiac Surgery: a Comprehensive Literature Review

“…The large variation in the incidence rate is dependent on the type of the surgical procedure performed, ranging from as high as 94% in heart transplantation to as low as 3% in thoracic surgery [3] . In addition, up to 52% of children are being diagnosed with AKI post cardiac surgery [4] , which can create huge socioeconomic burdens on clinical institutions et al [1] describes the risk associated with low cardiac output in either the pre, intra, or postoperative period and the increased likelihood of developing postoperative AKI due to reduced perfusion pressures and global renal ischaemic insult. This can be attributed to sympathetic hyperactivity and the simultaneous activation of the renin-angiotensin-aldosterone system, which leads to renal vasoconstriction and, hence, reduced renal perfusion [1] .…”

Predictors and outcome of acute kidney injury after non-cardiac paediatric surgery

“…Cumulatively, over the first 7 days of surgery, 35.5% of the patients developed AKI. These figures are closer to the lower end of the range of incidences reported from perioperative AKI secondary to cardiac or cardiopulmonary surgery [6,10,20,21]. The figures are also much higher than 3.13% that was reported among children from a wide range of paediatric wards, including paediatric surgery ward, intensive care unit, paediatric nephrology and hypertension units at Ile Ife, Nigeria, which is located close to where the study took place [7].…”

“…This implies that a large number of the paediatric population is likely to be exposed to major surgery. AKI has been extensively studied after paediatric cardiac surgery where prevalence of 9.6% to 65% has been recorded [10]. Conversely, there is a paucity of published literature on the occurrence of AKI in paediatric patients who underwent general (non-cardiac) surgical procedures.…”

Tissue alkaline phosphatase activity and expression in an experimental infant swine model of cardiopulmonary bypass with deep hypothermic circulatory arrest

“…[3] Unfortunately, these techniques are not benign and can lead to severe postoperative complications such as systemic in ammation and multiple organ injury. [4][5][6][7][8][9][10][11] Treatment for postoperative in ammation and organ injury is largely limited to supportive care.…”