estimated glomerular filtration rate monitoring in the Management of acute kidney injury among pediatric nephrology patients
DOI:
https://doi.org/10.5281/zenodo.22812994Keywords:
glomerular filtration rate, acute kidney injury, pediatric nephrology, chronic kidney disease, biomarkersAbstract
Background: Acute kidney injury (AKI) affects more than a quarter of critically ill children and is now recognized as a driver of long-term chronic kidney disease (CKD) rather than a self-limited event [2,27].
Objective: This review synthesizes the evidence on estimated glomerular filtration rate (eGFR) monitoring, its estimating equations, complementary injury biomarkers, and its role in AKI staging and long-term surveillance among pediatric nephrology patients.
Methods: We synthesized epidemiologic cohort studies, equation-validation studies, biomarker studies, and systematic reviews addressing pediatric AKI definitions, GFR-estimating equations, tubular injury biomarkers, and post-AKI renal outcomes.
Findings: Creatinine-based eGFR, most commonly the revised Schwartz equation, remains the practical monitoring backbone but lags true GFR change during acute injury [7]; cystatin C-based measures and biomarkers such as NGAL detect injury 24-48 hours earlier in specific settings [18,21], and structured post-discharge eGFR follow-up detects substantial persistent CKD risk after apparent recovery [25,26].
Conclusions: Pediatric nephrology services are best served by combining consistent KDIGO-based staging, an appropriately chosen and, where feasible, cystatin C-augmented eGFR equation, targeted biomarker use in defined high-risk exposures, and scheduled long-term eGFR follow-up.
References
Khwaja, A. (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Practice, 120(4): c179-184. DOI: 10.1159/000339789
Kaddourah, A., Basu, R.K., Bagshaw, S.M., Goldstein, S.L. (2017) Epidemiology of acute kidney injury in critically ill children and young adults. New England Journal of Medicine, 376(1): 11-20. DOI: 10.1056/NEJMoa1611391
Basu, R.K., Kaddourah, A., Terrell, T., Mottes, T., Arnold, P., Jacobs, J., et al. (2015) Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology in critically ill children (AWARE): a prospective study. Critical Care, 19: 28. DOI: 10.1186/s13054-015-0790-7
Sutherland, S.M., Ji, J., Sheikhi, F.H., Widen, E., Tian, L., Alexander, S.R., et al. (2013) AKI in hospitalized children: epidemiology and clinical associations in a national cohort. Clinical Journal of the American Society of Nephrology, 8(10): 1661-1669. DOI: 10.2215/CJN.00270113
Jetton, J.G., Boohaker, L.J., Sethi, S.K., Wazir, S., Rohatgi, S., Soranno, D.E., et al. (2017) Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child & Adolescent Health, 1(3): 184-194. DOI: 10.1016/S2352-4642(17)30069-X
Lameire, N.H., Bagga, A., Cruz, D., De Maeseneer, J., Endre, Z., Kellum, J.A., et al. (2013) Acute kidney injury: an increasing global concern. Lancet, 382(9887): 170-179. DOI: 10.1016/S0140-6736(13)60647-9
Schwartz, G.J., Munoz, A., Schneider, M.F., Mak, R.H., Kaskel, F., Warady, B.A., et al. (2009) New equations to estimate GFR in children with CKD. Journal of the American Society of Nephrology, 20(3): 629-637. DOI: 10.1681/ASN.2008030287
Furth, S.L., Cole, S.R., Moxey-Mims, M., Kaskel, F., Mak, R., Schwartz, G., et al. (2006) Design and methods of the Chronic Kidney Disease in Children (CKiD) prospective cohort study. Clinical Journal of the American Society of Nephrology, 1(5): 1006-1015. DOI: 10.2215/CJN.01941205
Devarajan, P. (2008) Neutrophil gelatinase-associated lipocalin (NGAL): a new marker of kidney disease. Scandinavian Journal of Clinical and Laboratory Investigation Supplementum, 241: 89-94. DOI:
1080/00365510802150158 10. Akcan-Arikan, A., Zappitelli, M., Loftis, L.L., Washburn, K.K., Jefferson, L.S., Goldstein, S.L. (2007) Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney International, 71(10): 1028-1035. DOI: 10.1038/sj.ki.5002231
Zappitelli, M., Parikh, C.R., Akcan-Arikan, A., Washburn, K.K., Moffett, B.S., Goldstein, S.L. (2008) Ascertainment and epidemiology of acute kidney injury varies with definition interpretation. Clinical Journal of the American Society of Nephrology, 3(4): 948-954. DOI: 10.2215/CJN.05431207
Sutherland, S.M., Byrnes, J.J., Kothari, M., Longhurst, C.A., Dutta, S., Garcia, P., et al. (2015) AKI in hospitalized children: comparison of the pRIFLE, AKIN, and KDIGO definitions. Clinical Journal of the American Society of Nephrology, 10(4): 554-561. DOI: 10.2215/CJN.01900214
Hui-Stickle, S., Brewer, E.D., Goldstein, S.L. (2005) Pediatric ARF epidemiology at a tertiary care center from 1999 to 2001. American Journal of Kidney Diseases, 45(1): 96-101. DOI: 10.1053/j.ajkd.2004.09.028
Basu, R.K., Zappitelli, M., Brunner, L., Wang, Y., Wong, H.R., Chawla, L.S., et al. (2014) Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children. Kidney International, 85(3): 659-667. DOI: 10.1038/ki.2013.349
Schwartz, G.J., Work, D.F. (2009) Measurement and estimation of GFR in children and adolescents. Clinical Journal of the American Society of Nephrology, 4(11): 1832-1843. DOI: 10.2215/CJN.01640309
Filler, G., Bokenkamp, A., Hofmann, W., Le Bricon, T., Martinez-Bru, C., Grubb, A. (2005) Cystatin C as a marker of GFR--history, indications, and future research. Clinical Biochemistry, 38(1): 1-8. DOI: 10.1016/j.clinbiochem.2004.09.025
Pottel, H., Hoste, L., Dhondt, A., Ghys, L., Coussement, J., Van Biesen, W., et al. (2016) An estimated glomerular filtration rate equation for the full age spectrum. Nephrology Dialysis Transplantation, 31(5): 798-806. DOI: 10.1093/ndt/gfv454
Herget-Rosenthal, S., Marggraf, G., Husing, J., Goring, F., Pietruck, F., Janssen, O., et al. (2004) Early detection of acute renal failure by serum cystatin C. Kidney International, 66(3): 1115-1122. DOI: 10.1111/j.1523-1755.2004.00861.x
Bagshaw, S.M., Bellomo, R. (2010) Cystatin C in acute kidney injury. Current Opinion in Critical Care, 16(6): 533-539. DOI: 10.1097/MCC.0b013e32833e8412
Zappitelli, M., Washburn, K.K., Arikan, A.A., Loftis, L., Ma, Q., Devarajan, P., et al. (2007) Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children. Critical Care, 11(4): R84. DOI: 10.1186/cc6089
Krawczeski, C.D., Woo, J.G., Wang, Y., Bennett, M.R., Ma, Q., Devarajan, P. (2011) Neutrophil gelatinase-associated lipocalin concentrations predict development of acute kidney injury in neonates and children after cardiopulmonary bypass. Journal of Pediatrics, 158(4): 1009-1015. DOI: 10.1016/j.jpeds.2010.12.057
Parikh, C.R., Devarajan, P., Zappitelli, M., Sint, K., Thiessen-Philbrook, H., Li, S., et al. (2011) Postoperative biomarkers predict acute kidney injury and poor outcomes after pediatric cardiac surgery. Journal of the American Society of Nephrology, 22(9): 1737-1747. DOI: 10.1681/ASN.2010111163
Basu, R.K., Wong, H.R., Krawczeski, C.D., Wheeler, D.S., Manning, P.B., Chawla, L.S., et al. (2014) Combining functional and tubular damage biomarkers improves diagnostic precision for acute kidney injury after cardiac surgery. Journal of the American College of Cardiology, 64(24): 2753-2762. DOI: 10.1016/j.jacc.2014.09.066
Bhatt, G.C., Das, R.R. (2015) Enhanced biomarkers for early detection of acute kidney injury in children: a systematic review. Pediatric Nephrology, 30(6): 857-873. DOI: 10.1007/s00467-014-2969-y
Askenazi, D.J., Feig, D.I., Graham, N.M., Hui-Stickle, S., Goldstein, S.L. (2006) 3-5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney International, 69(1): 184-189. DOI: 10.1038/sj.ki.5000032
Mammen, C., Al Abbas, A., Skippen, P., Nadel, H., Levine, D., Collet, J.P., et al. (2012) Long-term risk of CKD in children surviving episodes of acute kidney injury in the ICU: a prospective cohort study. American Journal of Kidney Diseases, 59(4): 523-530. DOI: 10.1053/j.ajkd.2011.10.048
Greenberg, J.H., Coca, S., Parikh, C.R. (2014) Long-term risk of chronic kidney disease and mortality in children after acute kidney injury: a systematic review. BMC Nephrology, 15: 184. DOI: 10.1186/1471-2369-15-184
Goldstein, S.L., Devarajan, P. (2011) Acute kidney injury in childhood: should we be worried about progression to CKD? Pediatric Nephrology, 26(4): 509-522. DOI: 10.1007/s00467-010-1653-4
Menon, S., Kirkendall, E.S., Nguyen, H., Goldstein, S.L. (2014) Acute kidney injury associated with high nephrotoxic medication exposure leads to chronic kidney disease after 6 months. Journal of Pediatrics, 165(3): 522-527. DOI: 10.1016/j.jpeds.2014.04.058
Goldstein, S.L., Kirkendall, E., Nguyen, H., Schaffzin, J.K., Bucuvalas, J., Bracke, T., et al. (2013) Electronic health record identification of nephrotoxin exposure and associated acute kidney injury. Pediatrics, 132(3): e756-767. DOI: 10.1542/peds.2013-0794
Goldstein, S.L., Mottes, T., Simpson, K., Barclay, C., Muething, S., Haslam, D.B., et al. (2016) A sustained quality improvement program reduces nephrotoxic medication-associated acute kidney injury. Kidney International, 90(1): 212-221. DOI: 10.1016/j.kint.2016.03.031
Sutherland, S.M., Zappitelli, M., Alexander, S.R., Chua, A.N., Brophy, P.D., Bunchman, T.E., et al. (2010) Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. American Journal of Kidney Diseases, 55(2): 316-325. DOI: 10.1053/j.ajkd.2009.10.048
Selewski, D.T., Cornell, T.T., Blatt, N.B., Han, Y.Y., Mottes, T., Kommareddi, M., et al. (2012) Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy. Critical Care Medicine, 40(9): 2694-2699. DOI: 10.1097/CCM.0b013e318258858a
Goldstein, S.L., Currier, H., Graf, C., Cosio, C.C., Brewer, E.D., Sachdeva, R. (2001) Outcome in children receiving continuous venovenous hemofiltration. Pediatrics, 107(6): 1309-1312. DOI: 10.1542/peds.107.6.1309
Chawla, L.S., Bellomo, R., Bihorac, A., Goldstein, S.L., Siew, E.D., Bagshaw, S.M., et al. (2017) Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nature Reviews Nephrology, 13(4): 241-257. DOI: 10.1038/nrneph.2017.2
Andreoli, S.P. (2009) Acute kidney injury in children. Pediatric Nephrology, 24(2): 253-263. DOI: 10.1007/s00467-008-1074-9
Published
Issue
Section
License
Copyright (c) 2022 Zola Banda, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
