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

Abstract

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.

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

“…Recently, the concept of a renal angina index has been proposed to direct biomarker assessment in noncardiac ICU patients who meet a certain level of risk and demonstrate signs of evolving AKI. 55,56 This concept has arisen due to concerns that widespread diagnostic testing may yield high numbers of false-positive results. 57 In the cardiac surgery setting, a similar parallel would be clinical risk scores.…”

Daño renal agudo en niños críticos: incidencia y factores de riesgo de mortalidad

“…1,30,31 Cabe mencionar algunas limitaciones de este estudio. En primer lugar, se deberá tener en cuenta que la patología de base de los pacientes fallecidos fue diferente de la de los sobrevivientes, hecho que pudo haber incidido en la posibilidad de morir; sin embargo, el número de pacientes incluidos es insuficiente para corroborar tal suposición.…”

“…1 El 5% a 12% de los niños que requieren internación en la unidad de terapia intensiva (UTI) presentan grados variables de a. Unidad de Nefrología. b. Servicio de Terapia Intensiva.…”

Fluid overload and kidney failure in children with severe sepsis and septic shock: A cohort study

“…1 One of the main causes of kidney failure is sepsis; approximately one-third of children with sepsis progress to kidney failure. 2 A t p r e s e n t , i n t r a v e n o u s replacement fluids in the initial t r e a t m e n t o f s e p s i s a n d s e p t i c shock are the fundamental pillars of hemodynamic management in these patients; however, it has been questioned that an excessive use of these fluids may cause a harmful effect on the disease course and any resulting complication. The use of an excessive fluid volume may be associated with an impairment in respiratory function, coagulopathy, and increased risk for brain swelling.…”