Subphenotypes of acute kidney injury in children

Abstract

Purpose of reviewThe purpose of this review is to describe acute kidney injury (AKI) phenotypes in children.Recent findingsAKI is a heterogenous disease that imposes significant morbidity and mortality on critically ill and noncritically ill patients across the age spectrum. As our understanding of AKI and its association with outcomes has improved, it is becoming increasingly apparent that there are distinct AKI subphenotypes that vary by cause or associated conditions. We have also learned that severity, duration, and repeated episodes of AKI impact outcomes, and that integration of novel urinary biomarkers of tubular injury can also reveal unique subphenotypes of AKI that may not be otherwise readily apparent.SummaryStudies that further delineate these unique AKI subphenotypes are needed to better understand the impact of AKI in children. Further delineation of these phenotypes has both prognostic and therapeutic implications.

Daily serum phosphate increase as early and reliable indicator of kidney injury in children with leukemia and lymphoma developing tumor lysis syndrome

“…With the development of biomarker-guided risk assessment [47], the nomenclature of kidney failure has broadened, and the use of tubular markers enables earlier recognition of AKI, which is important not only for optimizing treatment, but also for preventing chronic complications. This is complemented by the alert systems-one of the best-known of which is the RAI (renal angina index) [48,49].…”

Association of Urine Biomarkers With Acute Kidney Injury and Fluid Overload in Infants After Cardiac Surgery: A Single Center Ancillary Cohort of the Steroids to Reduce Systemic Inflammation After Infant Heart Surgery Trial

“…Conversely, a multicenter pilot study of 98 infants undergoing cardiac surgery found that uKIM-1 at 6 hours was associated with CS-AKI ( 34 ). The inconsistent association between urine biomarker concentrations and CS-AKI in infants is likely multifactorial but may be due to heterogeneous mechanisms of injury in CS-AKI or limitations of current CS-AKI definitions that fail to account for age- and disease-related renal changes in this population ( 35 – 37 ).…”

“…CS-AKI represents a heterogeneous disease process that both contributes to and is a consequence of FO ( 35 ). Capillary leak after bypass results in generalized fluid retention, which increases renal subcapsular pressure resulting in renal injury.…”

“…Similarly, lower renal blood flow and tubular dysfunction lead to lower urine output and fluid accumulation. Emerging literature suggests that CS-AKI has distinct phenotypes in relation to FO, reflecting different pathophysiologic mechanisms of injury ( 13 , 35 ). Categorizing infants by CS-AKI phenotype may allow for improved prognostic and therapeutic stratification.…”

“…While any renal injury can be detrimental, predicting which infants are most likely to develop severe CS-AKI and facilitating intervention may have a positive effect on outcomes. CS-AKI represents a heterogeneous disease process that both contributes to and is a consequence of FO (35). Capillary leak after bypass results in generalized fluid retention, which increases renal subcapsular pressure resulting in renal injury.…”