Pediatric Acute Kidney Injury

Fragasso, Tiziana; Ricci, Zaccaria; Goldstein, Stuart L.

doi:10.1159/000484968

Cited by 13 publications

(10 citation statements)

References 59 publications

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“…The presence of AKI in organ donors appears to impact the willingness to accept and transplant donor kidneys in China [25] . The incidence rate of AKI ranges from 25% to 52% within pediatric intensive care units [26,27] , and to augment the donor pool with systematic analysis of kidney transplants from pediatric donors with AKI, we found that although the incidence of DGF was higher in recipients of allografts with AKI, deceased donor AKI status itself did not affect death-censored graft and recipient survival. Patients with kidney transplants from a pediatric AKI donor had a superior recovery of allograft function.…”

Section: Discussionmentioning

confidence: 99%

Excellent Clinical Outcomes of Renal Transplant from Pediatric Deceased Donors with Acute Kidney Injury

Liu

Zhang

Zhong

et al. 2022

Preprint

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Background: The use of kidneys from deceased donors with acute kidney injury (AKI) to expand the donor pool is an ongoing trend. Prior research on the utilization of AKI donor kidneys, especially from pediatric AKI donors, was limited and has been subject to small sample sizes. In this study, we aimed to evaluate the safety and effectiveness of early post-transplantation outcomes in pediatric deceased donors with AKI. Methods: This retrospective study compared the clinical results (including delayed graft function [DGF], acute rejection, patient and death-censored graft survival rates and renal function post-transplant) of kidney transplantation from deceased donors who were categorized as pediatric donors and adult donors with or without AKI, as defined by the Kidney Disease: Improving Global Outcomes (KIDGO) criteria, at our center between January 2018 and December 2020. Results: Of the 740 patients, 154 received kidneys from pediatric donors (with AKI group [n=41]; without AKI group [n=113]), and 586 received kidneys from adult donors (with AKI group [n=218]; without AKI group [n=368]). The baseline characteristics were similar in both cohorts. No significant difference was observed in 1-year patient survival, death-censored graft survival, or acute rejection between the AKI and non-AKI groups in both the pediatric and adult cohorts. However, compared with those transplanted with adult AKI kidneys, those transplanted with pediatric AKI kidneys showed a superior recovery of allograft function. In pediatric cohorts, no significant difference was found in serum creatinine/estimated glomerular filtration rate (SCr/eGFR) between the AKI and non-AKI groups, even in the first week post-transplant. In contrast, the post-transplant SCr/eGFR level of the AKI group recipients in adult cohorts did not recover to a level statistically similar to that of non-AKI recipients, even at 6-months post-transplant. Nonetheless, AKI kidney recipients were at an increased risk of DGF in both pediatric (34.1% vs. 16.8%) and adult (38.5% vs. 17.4%) cohorts. Conclusions: Kidney transplantation from deceased donors with AKI has short-term clinical outcomes comparable to those of non-AKI kidney transplantation. Pediatric AKI kidneys have a superior recovery of allograft function. The transplant community should utilize this donor pool to minimize waiting-list-related mortalities.

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Section: Discussionmentioning

confidence: 99%

Excellent Clinical Outcomes of Renal Transplant from Pediatric Deceased Donors with Acute Kidney Injury

Liu

Zhang

Zhong

et al. 2022

Preprint

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“…When injury is severely beyond the kidney load, the kidney cannot complete self-repair and the remaining renal tubular epithelial cells lose cell polarity, showing continuous and uncontrolled proliferation of abnormalities (18). These paracrine products of renal tubular epithelial cells also interfere with the interaction between normal renal tubular epithelial cells, perivascular capillary endothelial cells and pericytes, resulting in epithelial to mesenchymal transformation, endothelial to mesenchymal transformation and pericytes to myofibroblast transformation (19). Myofibroblasts continue to proliferate and activate, secreting a large quantity of collagen fibers deposited in the renal parenchyma, gradually developing into renal interstitial fibrosis and progressing to end-stage renal disease (19).…”

Section: Discussionmentioning

confidence: 99%

“…These paracrine products of renal tubular epithelial cells also interfere with the interaction between normal renal tubular epithelial cells, perivascular capillary endothelial cells and pericytes, resulting in epithelial to mesenchymal transformation, endothelial to mesenchymal transformation and pericytes to myofibroblast transformation (19). Myofibroblasts continue to proliferate and activate, secreting a large quantity of collagen fibers deposited in the renal parenchyma, gradually developing into renal interstitial fibrosis and progressing to end-stage renal disease (19). Renal tubular epithelial cell injury is the initiating factor for the progression of AKI to chronic kidney disease (20).…”

Section: Discussionmentioning

confidence: 99%

Thioredoxin relieves lipopolysaccharide‑induced acute kidney injury in mice by reducing inflammation, oxidative stress and apoptosis

Wang

Zhang

Lu³

2021

Exp Ther Med

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Acute kidney injury (AKI) is a serious disease with rapid onset and a high mortality rate. It is therefore particularly important to identify a suitable method for treating AKI. Thioredoxin (Trx) is a potent anti-inflammatory and anti-oxidant protein that is prevalent in living organisms. The aim of the present study was to facilitate the clinical treatment of AKI via the study of Trx. Lipopolysaccharide (LPS) was used to construct an AKI model in mice and the mice were pre-treated with Trx to examine its effect on AKI. In addition, human renal tubular epithelial HK-2 cells were cultured and stimulated with Trx to examine its effect on inflammation, levels of oxidative stress and apoptosis in the HK-2 cells. The NF-κB signaling pathway is a classical inflammation-related pathway and the mechanism of Trx was investigated by evaluating the association between Trx and the NF-κB signaling pathway. Trx treatment reduced LPS-induced levels of inflammation, oxidative stress and apoptosis in the HK-2 cells. The activity of NF-κB signaling pathway was increased in LPS-induced HK-2 cells, while Trx treatment effectively reduced NF-κB signaling pathway activity. In addition, Trx treatment significantly reduced LPS-induced mouse AKI in vivo, which was characterized by a decrease in inflammatory factors in mouse serum, a decrease in AKI-associated molecules in mouse urine and a decrease in oxidative stress levels in mouse kidney tissue samples. Trx treatment reduced inflammation, levels of oxidative stress and apoptosis in HK-2 cells by inhibiting the NF-κB signaling pathway, thereby alleviating LPS-induced mouse AKI.

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“…Acute kidney injury (AKI) is a common complex disorder manifested as a rapid progress loss in renal excretory function, resulted by heterogenous etiologies [1,2]. The incidence of AKI has raised up to 27% in critically ill children in the past decades, occurring in both high-income and low-income country [3,4].…”

Section: Introductionmentioning

confidence: 99%

Renal Angina Index and Neutrophil-to-Lymphocyte Ratio: Predictive of Acute Kidney Injury in PICU

Peerapohn¹,

Samransamruajkit²,

Tawatchai³

2023

J Clin Nephrol Ren Care

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Background: Acute kidney injury (AKI) is associated with increased mortality in pediatric intensive care unit (PICU) patients. Early detection of AKI helps clinicians to manage promptly. Renal angina index (RAI) is established from changes in serum creatinine and condition of patients. Neutrophil-to-lymphocyte ratio (NLR) is calculated from a complete blood count (CBC). There are very few studies on the application of RAI and NLR in PICU. This study aims to evaluate the efficacy of RAI and NLR as AKI biomarker in PICU patients.Methods: A retrospective observational study was performed in 173 critically ill children, aged 1-15 yearsold, from August 2018 to November 2019. RAI and NLR were recorded on the day of PICU admission. The primary outcome was the diagnostic precision (sensitivity, specificity, negative predictive value (NPV) and summary receiveroperating characteristics (ROC) analysis) of RAI and NLR to predict subsequent AKI, AKI-requiring RRT and mortality within 28 days after admission to the PICU. Results:From the analysis of the 173 patients, RAI with a cutoff of 8 was associated with an area under the curve (AUC) of 0.71 in the ROC analysis with NPV of 98% to predict the subsequent AKI. The incorporation of NLR with a cutoff of 5.5 improved the performance of RAI, especially in the nonsurgical group to predict the needs for RRT, with an AUC of 0.88. Conclusion:RAI could be used as a reliable point-ofcare biomarker for the early detection of subsequent AKI. NLR improved the performance of RAI, especially in the nonsurgical group to predict the need for RRT.

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Pediatric Acute Kidney Injury

Cited by 13 publications

References 59 publications

Excellent Clinical Outcomes of Renal Transplant from Pediatric Deceased Donors with Acute Kidney Injury

Excellent Clinical Outcomes of Renal Transplant from Pediatric Deceased Donors with Acute Kidney Injury

Thioredoxin relieves lipopolysaccharide‑induced acute kidney injury in mice by reducing inflammation, oxidative stress and apoptosis

Renal Angina Index and Neutrophil-to-Lymphocyte Ratio: Predictive of Acute Kidney Injury in PICU

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