Approaches to the Management of Acute Kidney Injury in Children

Basu, Rajit K.; Wheeler, Derek S.

doi:10.2174/2210310411101010049

Cited by 2 publications

(2 citation statements)

References 87 publications

(94 reference statements)

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“…Neither dopamine [ 27 ] nor fenoldopam lessen their risk of mortality [ 28 ]. Therapy for oxidative and inflammatory kidney injury is largely speculative and has yet to be demonstrated as efficacious in large studies [ 29 ]. The use of renal replacement therapy (RRT) for inflammatory mediators in AKI is not globally supported [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Renal angina: an emerging paradigm to identify children at risk for acute kidney injury

et al. 2011

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Acute kidney injury (AKI) leads to high rates of morbidity and independently increases mortality risk. Therapy for AKI is likely limited by the inability to reliably diagnose AKI in its early stages, and, importantly, small changes in serum creatinine may be associated with poor outcomes and severe AKI. Whereas AKI biomarker research seeks to identify more sensitive and timely indices of kidney dysfunction, AKI lacks physical signs and symptoms to trigger biomarker assessment in at-risk patients, limiting biomarker efficacy. Accurate models of AKI prediction are unavailable. Severity of illness (SOI) scoring systems and organ dysfunction scores (OD), which stratify patients by prediction of mortality risk, are AKI reactive, not predictive. Kidneyspecific severity scores do not account for AKI progression, and stratification models of AKI severity are not predictive of AKI. Thus, there is a need for a kidney scoring system that can help predict the development of AKI. This review highlights the concept of renal angina, a combination of patient risk factors and subtle AKI, as a methodology to predict AKI progression. Fulfillment of renal angina criteria will improve the efficiency of AKI prediction by biomarkers, in turn expediting early therapy and assisting in creation of AKIpredictive scoring systems.

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Section: Introductionmentioning

confidence: 99%

Renal angina: an emerging paradigm to identify children at risk for acute kidney injury

et al. 2011

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“…The management of AKI is a predominantly conservative approach. There are few if any, interventions that proved to have an impact on the clinical course and outcome of AKI [5]. Hence the question-what is the role of furosemide in the management of AKI?…”

Section: Introductionmentioning

confidence: 99%

Trial of Furosemide to Prevent Acute Kidney Injury in Critically Ill Children: A Double-Blind, Randomized, Controlled Trial

et al. 2021

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Objective To study whether furosemide infusion in early-onset acute kidney injury (AKI) in critically ill children would be associated with a reduced proportion of patients progressing to the higher stage (Injury or Failure) as compared to placebo. Method A double-blind, placebo-controlled, randomized pilot trial was conducted. The authors enrolled children aged 1-mo (corrected) to 12-y, who were diagnosed with AKI ("risk" stage) using pediatric-Risk, Injury, Failure, Loss, End stage kidney disease (p-RIFLE) criteria, and achieved immediate resuscitation goals within 24 h of admission. Participants received either furosemide (0.05 to 0.4 mg/kg/h) or placebo (5%-dextrose) infusion. The primary outcome was the proportion of patients progressing to a higher stage (injury or failure). Secondary outcomes were (i) need for renal replacement therapy, (ii) the effect on neutrophil gelatinase-associated lipocalin (urine and blood), (iii) fluid balance, (iv) adverse effects, (v) time to achieve renal recovery, (vi) duration of hospital stay and mechanical ventilation, and (vii) all-cause 28-d mortality.Results The trial was stopped for futility, and data were analyzed on an intention-to-treat basis (furosemide-group: n = 38; placebo-group: n = 37). No significant difference was noted in the progression of AKI to a higher stage between furosemide and placebo groups (10.5% vs. 21.6%; relative risk = 0.49, 95% CI 0.16 to 1.48) (p = 0.22). There were no differences in the secondary outcomes between the study groups. All-cause 28-d mortality was similar between the groups (10.5% vs. 10.8%). No trial-related severe adverse events occurred. Conclusions Furosemide infusion in early-onset AKI did not reduce the progression to a higher stage of AKI. A future trial with large sample size is warranted.

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Approaches to the Management of Acute Kidney Injury in Children

Cited by 2 publications

References 87 publications

Renal angina: an emerging paradigm to identify children at risk for acute kidney injury

Renal angina: an emerging paradigm to identify children at risk for acute kidney injury

Trial of Furosemide to Prevent Acute Kidney Injury in Critically Ill Children: A Double-Blind, Randomized, Controlled Trial

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