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Review
. 2022 Oct 21:10:1039024.
doi: 10.3389/fped.2022.1039024. eCollection 2022.

Update on prognosis driven classification of pediatric AKI

Mital Patel  1 , Rasheed A Gbadegesin  1
Affiliations
Review

Update on prognosis driven classification of pediatric AKI

Mital Patel et al. Front Pediatr. .

Abstract

Acute kidney injury (AKI) affects a large proportion of hospitalized children and increases morbidity and mortality in this population. Initially thought to be a self-limiting condition with uniformly good prognosis, we now know that AKI can persist and progress to acute kidney disease (AKD) and chronic kidney disease (CKD). AKI is presently categorized by stage of injury defined by increase in creatinine, decrease in eGFR, or decrease in urine output. These commonly used biomarkers of acute kidney injury do not change until the injury is well established and are unable to detect early stage of the disease when intervention is likely to reverse injury. The kidneys have the ability to compensate and return serum creatinine to a normal or baseline level despite nephron loss in the setting of AKI possibly masking persistent dysfunction. Though these definitions are important, classifying children by their propensity for progression to AKD and CKD and defining these risk strata by other factors besides creatinine may allow for better prognosis driven discussion, expectation setting, and care for our patients. In order to develop a classification strategy, we must first be able to recognize children who are at risk for AKD and CKD based on modifiable and non-modifiable factors as well as early biomarkers that identify their risk of persistent injury. Prevention of initial injury, prompt evaluation and treatment if injury occurs, and mitigating further injury during the recovery period may be important factors in decreasing risk of AKD and CKD after AKI. This review will cover presently used definitions of AKI, AKD, and CKD, recent findings in epidemiology and risk factors for AKI to AKD to CKD progression, novel biomarkers for early identification of AKI and AKI that may progress to CKD and future directions for improving outcome in children with AKI.

Keywords: acute kidney disease; acute kidney injury; biomarkers; chronic kidney disease; prognostic model.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Proposed model for continuum of acute kidney injury (AKI), acute kidney disease (AKD), and chronic kidney disease (CKD).
Figure 2
Figure 2
Proposed schematic for biomarker and clinical tool-based prognostication for AKI-AKD-CKD progression and follow up nephrology care post AKI.
See this image and copyright information in PMC

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