Acute kidney injury in congenital diaphragmatic hernia requiring extracorporeal life support: an insidious problem

Gadepalli, Samir K.; Selewski, David T.; Drongowski, Robert A.; Mychaliska, George B.

doi:10.1016/j.jpedsurg.2010.11.031

Cited by 116 publications

(97 citation statements)

References 36 publications

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“…In response to the trends in the diagnosis of AKI, a number of neonatal studies were performed by using the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) and Acute Kidney Injury Network (AKIN) definitions of AKI. 8,45 One such standardized definition of AKI described in detail by Jetton and Askenazi is based on a modification of the KDIGO definition termed the neonatal modified KDIGO criteria (Table 1). This definition stages AKI based on an absolute rise in SCr from a previous trough and should be used in children ,120 days of age.…”

Section: Definition Of Neonatal Akimentioning

confidence: 99%

“…Perinatal risk factors associated with the development of AKI are outlined in Table 2 and include low Apgar scores, intubation, low cord pH, and asystole. [8][9][10]12,45,[47][48][49][50] …”

Section: Perinatal Exposures and Eventsmentioning

confidence: 99%

“…5,6 Neonatal AKI studies have begun to show similar conclusions: AKI is common and is associated with poor outcomes. [7][8][9][10][11][12] These studies remain limited to small single-center cohorts using varying definitions of AKI, making generalization difficult.…”

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confidence: 99%

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Neonatal Acute Kidney Injury

et al. 2015

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In recent years, there have been significant advancements in our understanding of acute kidney injury (AKI) and its impact on outcomes across medicine. Research based on single-center cohorts suggests that neonatal AKI is very common and associated with poor outcomes. In this state-of-the-art review on neonatal AKI, we highlight the unique aspects of neonatal renal physiology, definition, risk factors, epidemiology, outcomes, evaluation, and management of AKI in neonates. The changes in renal function with gestational and chronologic age are described. We put forth and describe the neonatal modified Kidney Diseases: Improving Global Outcomes AKI criteria and provide the rationale for its use as the standardized definition of neonatal AKI. We discuss risk factors for neonatal AKI and suggest which patient populations may warrant closer surveillance, including neonates ,1500 g, infants who experience perinatal asphyxia, near term/ term infants with low Apgar scores, those treated with extracorporeal membrane oxygenation, and those requiring cardiac surgery. We provide recommendations for the evaluation and treatment of these patients, including medications and renal replacement therapies. We discuss the need for long-term follow-up of neonates with AKI to identify those children who will go on to develop chronic kidney disease. This review highlights the deficits in our understanding of neonatal AKI that require further investigation. In an effort to begin to address these needs, the Neonatal Kidney Collaborative was formed in 2014 with the goal of better understanding neonatal AKI, beginning to answer critical questions, and improving outcomes in these vulnerable populations.

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Section: Definition Of Neonatal Akimentioning

confidence: 99%

Section: Perinatal Exposures and Eventsmentioning

confidence: 99%

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Neonatal Acute Kidney Injury

et al. 2015

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“…Moreover, AKI is an independent risk factor for prolonged mechanical ventilation and pediatric ICU mortality (1,4). Recently, our group and other research groups reported high incidences of AKI in children treated with extracorporeal membrane oxygenation (ECMO), who tend to be the most critically ill admitted to an ICU (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 98%

CKD and Hypertension during Long-Term Follow-Up in Children and Adolescents Previously Treated with Extracorporeal Membrane Oxygenation

Zwiers¹,

IJsselstijn²,

Rosmalen³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Many children receiving extracorporeal membrane oxygenation develop AKI. If AKI leads to permanent nephron loss, it may increase the risk of developing CKD. The prevalence of CKD and hypertension and its predictive factors during long-term follow-up of children and adolescents previously treated with neonatal extracorporeal membrane oxygenation were determined.Design, setting, participants, & measurements Between November of 2010 and February of 2014, neonatal survivors of extracorporeal membrane oxygenation who visited the prospective follow-up program at 1, 2, 5, 8, 12, and 18 years of age were screened for CKD and hypertension (BP$95th percentile of reference values). CKD was suspected in children with either an eGFR,90 ml/min per 1.73 m 2 or proteinuria (urinary protein-tocreatinine ratio .0.50 for children ages #24 months and .0.20 at .24 months). The RIFLE classification (risk, injury, or failure as 150%, 200%, or 300% of serum creatinine reference values) was used to define AKI during extracorporeal membrane oxygenation without preemptive hemofiltration.Results Median follow-up of 169 screened participants was 8.2 years (interquartile range=5.2-12.1 years). Nine children had a lower eGFR, but all rates were .60 ml/min per 1.73 m 2 . Proteinuria was observed in 20 children (median=0.26 mg protein/mg creatinine; interquartile range=0.23-0.32 mg protein/mg creatinine), and 32 children had hypertension. Only history of AKI was associated with CKD (P=0.004). Children with RIFLE scores injury and failure had 4.3 times higher odds of CKD signs or hypertension than those without AKI (95% confidence interval, 1.6 to 12.1; P=0.004).Conclusions Altogether, 54 participants (32%) had at least one sign of CKD and/or hypertension. However, most values were marginally abnormal, with no immediate consequences for clinical care. Nevertheless, a prevalence of 32% clearly indicates that survivors of neonatal extracorporeal membrane oxygenation, especially those with AKI, are at risk of a more rapid decline of kidney function with increasing age. Therefore, screening for CKD development in adulthood is recommended.

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“…The findings of single-center prospective studies in very low birth weight (VLBW) infants [1], infants who undergo cardiopulmonary bypass [2,3], infants requiring extracorporal pulmonary oxygenation [4,5], and infants with perinatal birth asphyxia [6] suggest that neonatal AKI is common and associated with poor outcomes [7,8]. To define AKI, these studies have used serum creatinine (SCr) alone, or SCr and urine output criteria.…”

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Are we ready for the clinical use of novel acute kidney injury biomarkers?

Askenazi

2012

Pediatr Nephrol

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Acute kidney injury (AKI) is a common event in several neonatal populations, and those neonates with AKI have poor outcomes. Serum creatinine (SCr)-based definitions of AKI are not ideal and are additionally limited in neonates whose SCr reflects the maternal creatinine level at birth and normally drops over the first weeks of life dependent on gestational age. Recent studies show that urine and serum biomarkers may provide a better basis than SCr on which to diagnose AKI. In this month's issue of Pediatric Nephrology, Sarafidis et al. show that urine neutrophil gelatinase-associated lipocalin (uNGAL), serum NGAL (sNGAL), and urine cystatin c (uCysC) are highest in those neonates with asphyxia who have elevated SCr. Furthermore, those with asphyxia without a concomitant rise in SCr levels have elevated levels of biomarkers compared to controls, suggesting a dose response. Once the SCr level returns to normal, the levels of novel AKI biomarkers continue to be elevated. While these findings strengthen the argument for the clinical use of these AKI biomarkers, further work is needed before they can be implemented in clinical practice. Large-scale observational multi-center studies are needed to test these biomarkers against hard clinical endpoints. In addition, randomized intervention trials which use biomarkers to define AKI need to be performed.Keywords Acute kidney injury . Ngal . Cystatin c . Asphyxia . Newborn . NeonatesOver the last few years our understanding of the incidence and outcomes in neonates who have acute kidney injury (AKI) has improved. The findings of single-center prospective studies in very low birth weight (VLBW) infants [1], infants who undergo cardiopulmonary bypass [2,3], infants requiring extracorporal pulmonary oxygenation [4,5], and infants with perinatal birth asphyxia [6] suggest that neonatal AKI is common and associated with poor outcomes [7,8]. To define AKI, these studies have used serum creatinine (SCr) alone, or SCr and urine output criteria. Although SCr is currently the most available method to define AKI, SCrbased AKI definitions are not ideal for numerous reasons. Firstly, because SCr is a measure of function (not injury), it is a late biomarker for an acute injury. Secondly, due to renal function reserve, more than 50 % of nephrons must be compromised before changes in SCr level are evident. Therefore, SCr is at best a late marker of significant renal dysfunction. In neonates, SCr-based AKI definitions are additionally complicated because at birth SCr reflects maternal creatinine, which improves over the first few weeks of life, dependent on gestational age [9]. For these and other reasons, newer definitions of a neonatal AKI using noninvasive serum and urine biomarkers are greatly needed.Studies in VLBW infants [10,11], infants who undergo cardiopulmonary bypass surgery [3,[12][13][14][15][16][17], and other sick newborns admitted to a neonatal intensive care unit [18] suggest that such biomarkers can detect those infants who will later have a rise in SCr and that...

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Acute kidney injury in congenital diaphragmatic hernia requiring extracorporeal life support: an insidious problem

Cited by 116 publications

References 36 publications

Neonatal Acute Kidney Injury

Neonatal Acute Kidney Injury

CKD and Hypertension during Long-Term Follow-Up in Children and Adolescents Previously Treated with Extracorporeal Membrane Oxygenation

Are we ready for the clinical use of novel acute kidney injury biomarkers?

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