Acute Kidney Injury: It’s Not Just Acute, and It’s Not Just the Kidneys

Acute kidney injury (AKI) is common in hospitalized children. AKI has been shown to be associated with increased hospital mortality, length of stay and costs. The poor outcomes incurred by AKI are thought to be related to the systemic sequelae of AKI, which often remain unacknowledged by clinicians. Children who survive an AKI hospitalization are more likely than children without AKI to develop chronic kidney disease (CKD), hypertension and to be at risk for higher long-term morbidity. Rates of AKI are roughly ~20%, 30% and 40-60% in pediatric, neonatal and cardiac intensive care units, respectively. Nephrotoxic mediated AKI (NAKI) is the most common cause of AKI in non-critically ill hospitalized children. Many episodes of NAKI are preventable, and stewardship programs have been shown to reduce the rate, severity and duration of NAKI. Still, many episodes of hospital-acquired AKI go unrecognized by providers.

Herein, this Research Topic aims to provide an update on best practices for the prevention, early detection, management and follow-up of pediatric acute kidney injury. Contributions will focus on recent improvements in neonatal, pediatric and cardiac intensive care, as well as general ward AKI. The current state of clinical decision support and alert tools will be reviewed with a thought towards our future ideal state in the prevention and early detection of AKI.

We will also provide updates on the pathophysiology of AKI and its systemic effects on short-term and long-term patient outcomes. With the long-term effects of AKI in mind, we welcome contributions exploring the impact of pediatric AKI on long-term population health, health care costs, and how we can potentially improve care now in order to optimize our pediatric patients’ health later in life.

This Research Topic will focus on, but is not limited to:
• Pathophysiology of AKI;
• Epidemiology and outcomes of various types of pediatric AKI (sepsis, oncologic, nephrotoxic, cardiac, hepatorenal);
• Short-term morbidity and mortality associated with AKI;
• Systemic effects of AKI;
• Long-term renal sequalae of AKI;
• Long-term non-renal sequalae of AKI;
• Impact of pediatric disease on long-term population health;
• Clinical utilization of biomarkers for early detection and prediction of long-term outcomes after AKI;
• Quality improvement efforts for prevention, detection, management and follow-up of AKI in hospitalized and non-hospitalized patients;
• Practice patterns/process of care of long-term AKI follow-up: lessons from adult studies and emerging pediatric data.

Dr. Katja Gist is a consultant for BioPorto diagnostics. All other Topic Editors declare no competing interests with regards to the Research Topic subject.