Early detection of acute kidney injury after pediatric cardiac surgery

Abstract

Acute kidney injury (AKI) is increasingly recognized as a common problem in children undergoing cardiac surgery, with well documented increases in morbidity and mortality in both the short and the long term. Traditional approaches to the identification of AKI such as changes in serum creatinine have revealed a large incidence in this population with significant negative impact on clinical outcomes. However, the traditional diagnostic approaches to AKI diagnosis have inherent limitations that may lead to under-diagnosis of this pathologic process. There is a dearth of randomized controlled trials for the prevention and treatment of AKI associated with cardiac surgery, at least in part due to the paucity of early predictive biomarkers. Novel non-invasive biomarkers have ushered in a new era that allows for earlier detection of AKI. With these new diagnostic tools, a more consistent approach can be employed across centers that may facilitate a more accurate representation of the actual prevalence of AKI and more importantly, clinical investigation that may minimize the occurrence of AKI following pediatric cardiac surgery. A thoughtful management approach is necessary to mitigate the effects of AKI after cardiac surgery, which is best accomplished in close collaboration with pediatric nephrologists. Long-term surveillance for improvement in kidney function and potential development of chronic kidney disease should also be a part of the comprehensive management strategy.

Early detection of cardiac surgery‑associated acute kidney injury by microRNA-21

“…CSA-AKI is an important complication of major cardiac surgeries. The defi nition of CSA-AKI based on the decrease in GFR or increase in creatinine level is not applicable for early diagnosis of CSA-AKI (6,31,32). These markers are useful 24 h after cardiac surgeries.…”

Acute kidney injury in children after cardiac surgery: Risk factors and outcomes. A retrospective, cohort study

“…The incidence of AKI in our patients, as per the KDIGO criteria, was 35 %, which is slightly below what has been described in the bibliography. 1,[3][4][5]19 Such difference is attributed to the fact that most of e562 / Arch Argent Pediatr 2019;117(6):e557-e567 / Original article the published case reports defined AKI as per the pRIFLE criteria (before the validation of the KDIGO criteria in pediatrics), which had a greater sensitivity and a lower specificity, 19,20 especially in the first stages of risk. Most cases developed in the first day after the surgery; the criteria for stage 1 AKI were met; and AKI was resolved in the first 24 h, similar to what has been described to date.…”

“…[2][3][4] Delayed growth, hypertension, and chronic kidney failure have been described in the long term. 5,6 The risk factors include high preoperative blood creatinine levels, age younger than 1 year, prolonged extracorporeal circulation time, higher inotrope requirements, and low postoperative cardiac output. 1,3,7 Likewise, an association has been described with the greater surgery complexity, 8 which is reflected on the risk adjustment for congenital heart surgery (RACHS-1) category.…”

“…[13][14][15] The pathophysiology of AKI in these patients involves multiple mechanisms: a low cardiac output, the release of pro inflammatory cytokines, the ischemia-reperfusion phenomenon, blood mechanical trauma, oxidative stress, and nephrotoxins. 5,15 Identifying the risk factors would allow to develop strategies aimed at reducing morbidity and mortality. Therefore, the objective of this study was to estimate the incidence of AKI in patients who underwent cardiovascular surgery and to determine the associated risk factors and the impact of AKI on the parameters of the postoperative course.…”

Pediatric acute kidney injury: prevalence, impact and management challenges

“…Cardiac surgery-associated acute kidney injury (CS-AKI) is a common cause of AKI in children, with a reported incidence of 20-60%. 24 However, the increase in serum creatinine typically occurs only 1-3 days after cardiopulmonary bypass (CPB). As first highlighted by Mishra et al, 25 a dramatic increase in both urine and plasma NGAL is detected within 2-6 hours of CPB in children destined for AKI, with a predictive area under the receiver operating characteristic curve (AUC) of >0.9.…”