The Evolution of Acute Kidney Injury Research Over the Past Two Decades

Abstract

The recognition that patients are dying from and not with acute kidney injury has prompted a transformation in clinical, basic, and translational acute kidney injury research over the past two decades. Initial work described the single-center epidemiology and associated outcomes for children with acute kidney injury who required support with renal replacement therapy. More recent study focuses on risk stratification, discovery validation, and incorporation of novel biomarkers into the prediction of acute kidney injury and description of its course. Finally, two large multicenter and multinational studies of pediatric and neonatal acute kidney injury demonstrate the irrefutable incremental risk conferred by pediatric acute kidney injury and morbidity and mortality across the spectrum of pediatric critical illness. All of these advancements were made possible by development of a standardized multidimensional definition of acute kidney injury development and severity. The evolution of pediatric acute kidney injury research in the past two decades provides the foundation necessary and optimism for the future to improve outcomes for the critically ill child with or at risk for acute kidney injury.