Center for Acute Care Nephrology

Cincinnati, OH, United States

Center for Acute Care Nephrology

Cincinnati, OH, United States
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News Article | November 18, 2016
Site: www.eurekalert.org

CINCINNATI -- One of every four children admitted to pediatric intensive care units around the world develops acute kidney injury (AKI), which increases the risk of death as well as longer and more intensive hospitalizations, according to a study published online in The New England Journal of Medicine. Moreover, the nearly 12 percent who develop more severe AKI have a further increased risk of death within 28 days, according to lead author Stuart L. Goldstein, MD, director of the Center for Acute Care Nephrology at Cincinnati Children's Hospital Medical Center. "The common and early occurrence of acute kidney injury reinforces the need for systematic surveillance for AKI at the time patients are admitted to intensive care," says Dr. Goldstein. "Severe AKI was associated with an increased need for mechanical ventilation to assist breathing, and with renal replacement therapy (acute dialysis). Since children who survive AKI are at risk for developing chronic kidney disease, long-term follow up of these survivors is warranted." Dr. Goldstein and his colleagues collected data from 5,297 patients admitted to 32 pediatric intensive care units in nine countries around the world. To determine AKI, the researchers measured both urine output volumes and levels of creatinine in the blood. Creatinine is a chemical waste molecule transported through the bloodstream to the kidneys, which filter most of the waste and deposit it in the urine. The researchers discovered that severe AKI based on decreased urine output increases the risk of death compared to AKI based on creatinine levels. Assessment using blood creatinine levels alone missed AKI in two thirds of patients with oliguria (a particular measured volume of decreased urine output), and oliguria alone conferred increased mortality risk, according to Dr. Goldstein. This reinforces the importance of using both measures to detect AKI, which he says is not commonly done. The AWARE (Assessment of Worldwide AKI, Renal angina and Epidemiology in children) study was coordinated by the Center for Acute Care Nephrology at Cincinnati Children's. Working closely with other divisions within Cincinnati Children's, the center monitors, detects and treats kidney injury before it causes irreparable damage. The study is being published in conjunction with presentation of the data at Kidney Week 2016, the American Society of Nephrology's annual meeting, in Chicago. The study was supported, in part, by funding from the National Institutes of Health (NIH P50 DK096418). Rajit Basu, MD, a physician in the division of Critical Care Medicine at Cincinnati Children's, was co-lead author of the study. Fourteen subsequent manuscripts are planned for the AWARE dataset. These will include the assessment of novel AKI biomarkers and an early AKI risk scoring system to improve early detection and prediction of severe AKI.


Riley A.A.,Baylor College of Medicine | Jefferies J.L.,Center for Acute Care Nephrology | Jefferies J.L.,Cincinnati Childrens Hospital Medical Center | Nelson D.P.,Center for Acute Care Nephrology | And 7 more authors.
International Journal of Artificial Organs | Year: 2014

Purpose: Acute kidney injury (AKI) after cardiopulmonary bypass surgery to correct congenital heart disease is common. We prevent fluid overload and further cardiac compromise in oliguric infants with continuous peritoneal dialysis (CPD). The effect of CPD on kidney recovery is unknown, thus indications to discontinue CPD are unclear. We aimed to determine if CPD affects kidney recovery, measured by urine output and novel urinary AKI biomarker concentrations. Methods: Twenty infants <90 days old with congenital heart disease who underwent bypass surgery and were post-operatively treated with CPD were randomized at the time of clinical readiness for CPD discontinuation to 1) discontinue CPD (control) or 2) continue 24 h more CPD (experimental). Urine output (ml/kg per h), total output (ml/kg per h) and urinary neutrophil gelatinase-associated lipocalin, interleukin-18, liver-type fatty acid binding protein, and kidney injury molecule-1 were assessed postsurgery until CPD catheter removal. Results: 24 hours preceding randomization, there were no differences in mean urine output or total output; 24 hours post-randomization, the control group had higher mean urine output (4.2 ± 2.6 ml/kg per h vs. 2.8 ± 2.0 ml/kg per h, p = 0.02) but lower total output (6.3 ± 2.1 ml/kg per h vs. 4.7 ± 2.7 ml/kg per h, p = 0.01). Median biomarker concentrations did not differ significantly between groups at any time point. Conclusions: Our results suggest renal replacement therapy does not change the time course of kidney function recovery. © 2014 Wichtig Editore.


Basu R.K.,Center for Acute Care Nephrology | Basu R.K.,Cincinnati Childrens Hospital Medical Center | Basu R.K.,University of Cincinnati | Wheeler D.S.,Center for Acute Care Nephrology | And 2 more authors.
Pediatric Nephrology | Year: 2013

There is a growing appreciation for the role that acute kidney injury (AKI) plays in the propagation of critical illness. In children, AKI is not only an independent predictor of morbidity and mortality, but is also associated with especially negative outcomes when concurrent with acute lung injury (ALI). Experimental data provide evidence that kidney-lung crosstalk occurs and can be bidirectionally deleterious, although details of the precise molecular mechanisms involved in the AKI-ALI interaction remain incomplete. Clinically, ALI, and the subsequent clinical interventions used to stabilize gas exchange, carry consequences for the homeostasis of kidney function. Meanwhile, AKI negatively affects lung physiology significantly by altering the homeostasis of fluid balance, acid-base balance, and vascular tone. Experimental AKI research supports an "endocrine" role for the kidney, triggering a cascade of extra-renal inflammatory responses affecting lung homeostasis. In this review, we will discuss the pathophysiology of kidney-lung crosstalk, the multiple pathways by which AKI affects kidney-lung homeostasis, and discuss how these phenomena may be unique in critically ill children. Understanding how AKI may affect a "balance of communication" that exists between the kidneys and the lungs is requisite when managing critically ill children, in whom imbalance is the norm. © 2013 IPNA.


Kaddourah A.,Center for Acute Care Nephrology | Kaddourah A.,Sidra Medical and Research Center | Goldstein S.L.,Center for Acute Care Nephrology | Goldstein S.L.,Burnet Institute | And 8 more authors.
Pediatric Nephrology | Year: 2016

Background: Evolving data suggest tubular injury markers (TIM) to be diagnostic and prognostic biomarkers of kidney injury in adults with chronic cardiac dysfunction. Such data are not well delineated in asymptomatic children with cardiomyopathy. This study sought to evaluate kidney involvement in children with left ventricular (LV) systolic dysfunction. Methods: We conducted a cross-sectional case–control study in 61 asymptomatic children (aged 1.7–21.9 years) with dilated cardiomyopathy (DCM) and LV ejection fraction (LVEF) < 55 %. Routine conventional kidney function markers and the following urinary TIM were measured: KIM-1, IL-18, neutrophil gelatinase-associated lipocalin (NGAL), and L-FABP. Characteristics and TIM data of cases were compared with those of 61 age- and gender-matched healthy controls. Results: Children with DCM had higher TIM concentrations compared with controls for IL-18 (28.2 pg/mg, IQR [15.9–42.5] vs19.0 [12.6–28.6], p < 0.001), NGAL (13.2 ng/mg [6.5–44.3] vs 8.3 [3.1–17.5], p = 0.01), and KIM-1 (386 pg/mg (248–597) vs 307 [182–432], p = 0.02). All conventional kidney function markers were within normal limits in the DCM cohort. A combined model using cut-off values of KIM-1 ≥ 235, IL-18 ≥ 17.5, and (BNP) > 15 pg/ml resulted in distinction between patients with mildly depressed LV (55 > LVEF ≥ 45) and those with LVEF < 45 %. The sensitivity of this model was ≥80 % when any of the cut-off values was met and specificity 83 % when all cut-off values were met. Conclusions: Our data suggest that asymptomatic children with LVEF < 55 % might have subclinical kidney injury that cannot be detected with conventional kidney function markers. TIM in conjunction with other cardiac function markers may be utilized to distinguish asymptomatic children with DCM and moderate or worse LV dysfunction (LFEV < 45 %) from those with mild LV dysfunction (55 > LVEF ≥ 45 %). © 2016 IPNA


PubMed | Cincinnati Childrens Hospital Medical Center and Center for Acute Care Nephrology
Type: Journal Article | Journal: Pediatric nephrology (Berlin, Germany) | Year: 2016

Evolving data suggest tubular injury markers (TIM) to be diagnostic and prognostic biomarkers of kidney injury in adults with chronic cardiac dysfunction. Such data are not well delineated in asymptomatic children with cardiomyopathy. This study sought to evaluate kidney involvement in children with left ventricular (LV) systolic dysfunction.We conducted a cross-sectional case-control study in 61 asymptomatic children (aged 1.7-21.9years) with dilated cardiomyopathy (DCM) and LV ejection fraction (LVEF)<55%. Routine conventional kidney function markers and the following urinary TIM were measured: KIM-1, IL-18, neutrophil gelatinase-associated lipocalin (NGAL), and L-FABP. Characteristics and TIM data of cases were compared with those of 61 age- and gender-matched healthy controls.Children with DCM had higher TIM concentrations compared with controls for IL-18 (28.2pg/mg, IQR [15.9-42.5] vs19.0 [12.6-28.6], p<0.001), NGAL (13.2ng/mg [6.5-44.3] vs 8.3 [3.1-17.5], p=0.01), and KIM-1 (386pg/mg (248-597) vs 307 [182-432], p=0.02). All conventional kidney function markers were within normal limits in the DCM cohort. A combined model using cut-off values of KIM-1235, IL-1817.5, and (BNP)>15pg/ml resulted in distinction between patients with mildly depressed LV (55>LVEF45) and those with LVEF<45%. The sensitivity of this model was 80% when any of the cut-off values was met and specificity 83% when all cut-off values were met.Our data suggest that asymptomatic children with LVEF<55% might have subclinical kidney injury that cannot be detected with conventional kidney function markers. TIM in conjunction with other cardiac function markers may be utilized to distinguish asymptomatic children with DCM and moderate or worse LV dysfunction (LFEV<45%) from those with mild LV dysfunction (55>LVEF45%).

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