Srpski arhiv za celokupno lekarstvo 2014 Volume 142, Issue 5-6, Pages: 371-377
https://doi.org/10.2298/SARH1406371P
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Acute kidney injury in children
Peco-Antić Amira (School of Medicine, Belgrade + University Children’s Hospital, Nephrology Department, Belgrade)
Paripović Dušan (University Children’s Hospital, Nephrology Department, Belgrade)
Acute kidney injury (AKI) is a clinical condition considered to be the
consequence of a sudden decrease (>25%) or discontinuation of renal function.
The term AKI is used instead of the previous term acute renal failure,
because it has been demonstrated that even minor renal lesions may cause
far-reaching consequences on human health. Contemporary classifications of
AKI (RIFLE and AKIN) are based on the change of serum creatinine and urinary
output. In the developed countries, AKI is most often caused by renal
ischemia, nephrotoxins and sepsis, rather than a (primary) diffuse renal
disease, such as glomerulonephritis, interstitial nephritis, renovascular
disorder and thrombotic microangiopathy. The main risk factors for hospital
AKI are mechanical ventilation, use of vasoactive drugs, stem cell
transplantation and diuretic-resistant hypervolemia. Prerenal and parenchymal
AKI (previously known as acute tubular necrosis) jointly account for 2/3 of
all AKI causes. Diuresis and serum creatinine concentration are not early
diagnostic markers of AKI. Potential early biomarkers of AKI are neutrophil
gelatinase-associated lipocalin (NGAL), cystatin C, kidney injury molecule-1
(KIM-1), interleukins 6, 8 and 18, and liver-type fatty acid-binding protein
(L-FABP). Early detection of kidney impairment, before the increase of serum
creatinine, is important for timely initiated therapy and recovery. The goal
of AKI treatment is to normalize the fluid and electrolyte status, as well as
the correction of acidosis and blood pressure. Since a severe fluid overload
resistant to diuretics and inotropic agents is associated with a poor
outcome, the initiation of dialysis should not be delayed. The mortality rate
of AKI is highest in critically ill children with multiple organ failure and
hemodynamically unstable patients.
Keywords: acute kidney injury, acute tubular necrosis, children