Long-Term Outcome of Acute Kidney Injury in Children: A Practical Approach for Follow-up
Acute kidney injury (AKI) in critically ill children is common and strongly associated with poor hospital outcomes. The potential importance of AKI as a contributor to poor long-term health in children has only recently been appreciated. Very few children require acute renal replacement therapy for severe AKI. Few healthcare providers would argue that children requiring acute dialysis need follow-up after hospital discharge to ensure that kidney function returns to, and remains, normal. However, a dilemma lies with children who develop non-dialysis-requiring AKI: are they at risk for long-term kidney disease, and if so, how should they be followed and by whom? There are no concrete guidelines on who and how to follow pediatric AKI after hospital discharge; thus, many children with AKI are likely not followed for long-term kidney disease development. Instituting systematic follow-up of pediatric AKI must balance potential benefits (early CKD detection/treatment) with burden to families and healthcare systems. This chapter will briefly summarize the rationale for long-term follow-up of pediatric AKI and briefly review the limited current evidence on pediatric long-term AKI-outcome associations. In the context of an evolving evidence base, this chapter will provide a practical approach to following up children who develop AKI during hospitalization.
KeywordsPediatric Critically ill Kidney dysfunction Chronic kidney disease Hypertension Nephrotoxins Glomerular filtration rate Proteinuria Blood pressure
- 1.Alkandari O, Eddington KA, Hyder A, et al. Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study. Crit Care. 2011;15(3):R146.CrossRefGoogle Scholar
- 11.Kavey RE, Allada V, Daniels SR, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2006;114(24):2710–38.CrossRefGoogle Scholar
- 21.Knijnenburg SL, Mulder RL, Schouten-Van Meeteren AY, et al. Early and late renal adverse effects after potentially nephrotoxic treatment for childhood cancer. Cochrane Database Syst Rev. 2013;10:CD008944.Google Scholar