Treating Acute Kidney Injury in Children Beyond Kideny Replacement Therapy

Biomarkers May Help Early Diagnosis of Acute Kidney Injury in Children

Serum creatinine (serum creatinine, SCr) is a common laboratory index for monitoring renal function, but SCr can be affected by factors such as age and gender and is not a sensitive index; while urine output is more easily affected by volume load, drugs, etc. Influence of non-renal factors. Therefore, biomarkers that can predict AKI before SCr rises, assist in the etiological diagnosis of AKI, and predict the degree and duration of AKI damage have attracted extensive attention from researchers.

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Biomarkers are inspection items with good accuracy for the assessment and prognosis of PAKI. Among them, is the biomarker of renal tubular injury-Neutrophil Gelatinase-associated Lipocalin (NGAL)[ 5] The research results and value are quite considerable.

Studies have shown that after renal dysfunction, the expression of NGAL in the kidney increases significantly, and NGAL may inhibit the accumulation of renal toxins by reducing apoptosis and increasing proliferation of renal tubular cells, while leading to hypernatremia-related No significant expression of NGAL was found in prerenal disease, indicating that prerenal disease will not induce excessive expression of NGAL, so NGAL is also helpful in the differential diagnosis of whether the cause is prerenal disease [6], and it has a better early diagnosis and the role of identifying etiology.

Kidney injury molecule-1 (kidney injury molecule-1, KIM-1) KIM was also found to be significantly elevated within a short period after AKI and reached its peak 2–3 days after proximal renal tubular injury [7]. Therefore, the advantages of KIM-1 as a diagnostic biomarker for AKI lie in its timeliness and specificity to ischemic kidney injury. Compared with patients with normal renal function and CKD, urinary KIM-1 was significantly higher in patients with acute tubular necrosis. Urinary KIM-1 levels can predict adverse clinical outcomes in patients with multiple causes of AKI, such as dialysis and mortality [8]. It should be noted that renal cancer patients can also detect elevated urinary KIM-1 levels, which may reduce the specificity of AKI early warning.

Previous studies have confirmed that KIM-1 and NGAL in urine and kidney tissue were significantly increased in children with NS complicated with AKI, which means that KIM-1 and NGAL are important cytokines that reflect changes in renal function and are useful for early judgment of children with AKI. Renal dysfunction has important clinical significance, suggesting that changes in urinary KIM-1 and NGAL may be used to diagnose AKI based on NS in children[9].

In addition, some studies have also found that the level of interleukin-18 (IL-18) in the urine begins to rise 4-6 hours after renal injury, and reaches a peak at 12 hours, which is significantly earlier than SCr[10]. The results of the meta-analysis suggest that IL-18 has the potential to predict the severity of AKI[11], but its sensitivity and specificity are low, and it can be increased by diseases other than AKI. Therefore, although IL-18 is not one of the preferred biomarkers for early diagnosis of AKI, the diagnostic value of IL-18 can be improved by combining it with other biomarkers.

Here's what you need to do to prevent acute kidney injury in children...

1 Primary prevention of acute kidney injury in children

That is, prevention should be carried out when the children have not been diagnosed with AKI, such as avoiding nephrotoxic drugs and non-steroidal resistance drugs as much as possible.

2 Secondary prevention of acute kidney injury in children

Secondary prevention advocates early detection, early diagnosis, and early treatment, and screening can be carried out in risk groups. Risk groups for PAKI include children in the ICU, children with CKD, and children with congenital heart disease. Doctors should always pay attention to the renal perfusion and renal function of these children.

Given the extremely high mortality rate of AKI, doctors should try their best to limit the progress of the disease before it develops, to reduce the mortality rate of AKI in critically ill children from the root!

① Avoid the use of nephrotoxic drugs as much as possible.

②Before starting to use nephrotoxic drugs, make sure that the children's renal perfusion is normal.

③Use the lowest effective dose and shortest course of treatment for all drugs possible.

④ Children with chronic pain or fever should use analgesics with the lowest prostaglandin activity, such as acetaminophen.

⑤ When children show signs of toxicity, the dose of nephrotoxic drugs should be stopped or reduced.

⑥ Use the lowest dose of low-permeability contrast medium for children with renal insufficiency, heart failure, and diabetes, and continuously monitor the enhanced Glomerular Filtration Rate (eGFR) within 48 hours of exposure.

⑦Intravenous infusion of theophylline within the first hour after birth can improve fluid balance, and creatinine clearance, and reduce SCr levels in severely asphyxiated neonates, but does not affect neurological and respiratory complications[12].

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