Abstract
Pediatric acute kidney injury (AKI) is a major cause of morbidity and mortality in children undergoing interventional procedures. The review summarizes current classifications of AKI and acute kidney disease (AKD), as well as systematizes the knowledge on pathophysiology of kidney injury, with a special focus on renal functional reserve and tubuloglomerular feedback. The aim of this review is also to show the state-of-the-art in methods assessing risk and prognosis by discussing the potential role of risk stratification strategies, taking into account both glomerular function and clinical settings conditioned by fluid overload, urine output, or drug nephrotoxicity. The last task is to suggest careful assessment of eGFR as a surrogate marker of renal functional reserve and implementation of point-of-care testing, available in the case of biomarkers like NGAL and [IGFBP-7] × [TIMP-2] product, into everyday practice in patients at risk of AKI due to planned invasive procedures or treatment.
Highlights
Injury—Are We Ready to TranslatePediatric acute kidney injury (AKI) is a serious clinical condition, associated with increased morbidity and mortality, as reported in large observational studies like AWARE (Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology) or AWAKEN (Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates) [1,2,3].Yet, defining an efficient and reliable tool for kidney injury assessment in children is still a challenge
Out of a wide range of candidates, only NGAL and [IGFBP7] × [Tissue Inhibitor of Metalloproteinase (TIMP)-2] product were put into the form of of candidates, only NGAL and [IGFBP7] × [TIMP-2] product were put into the form of point-of-care testing, serving as diagnostic tools
Current concepts of the nature of AKI show the complexity of interrelations between glomerular and tubular function, as well as the paramount role of cell damage in the early phase of AKI or even before it
Summary
Pediatric acute kidney injury (AKI) is a serious clinical condition, associated with increased morbidity and mortality, as reported in large observational studies like AWARE (Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology) or AWAKEN (Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates) [1,2,3]. While methods of evaluating renal function in stable milieu are established, the real task is how to predict the kidney ability to preserve function despite injury under stress conditions. The history of progress in diagnosing kidney injury and predicting prognosis screens through various classifications, identification of risk factors, discovery and increasing role of damage biomarkers, evaluation of renal functional reserve and usage of stress tests, and search for predictors of progression from AKI to CKD or of recovery.
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