Current Concepts of Pediatric Acute Kidney Injury-Are We Ready to Translate Them into Everyday Practice?

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.

Keywords: NGAL; [IGFBP-7] × [TIMP-2]; furosemide stress test; hyperfiltration; renal angina index; renal functional reserve; tubular damage; tubuloglomerular feedback.

Figure 1

Expanded acute kidney injury (AKI) criteria combining function and damage biomarkers, glomerular functional reserve (GFR), and tubular functional reserve (TFR) (according to [10], modified).