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Acute Kidney Injury and Cardiorenal Syndromes in Pediatric Cardiac Intensive Care

Cooper, David S. MD, MPH1; Kwiatkowski, David M. MD2; Goldstein, Stuart L. MD3; Krawczeski, Catherine D. MD4

Pediatric Critical Care Medicine: August 2016 - Volume 17 - Issue 8 - p S250-S256
doi: 10.1097/PCC.0000000000000820
Organ Systems: Other Organ Systems and Systemic Disorders
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Objectives: The objectives of this review are to discuss the definition, diagnosis, and pathophysiology of acute kidney injury and its impact on immediate, short-, and long-term outcomes. In addition, the spectrum of cardiorenal syndromes will be reviewed including the pathophysiology on this interaction and its impact on outcomes.

Data Source: MEDLINE and PubMed.

Conclusion: The field of cardiac intensive care continues to advance in tandem with congenital heart surgery. As mortality has become a rare occurrence, the focus of cardiac intensive care has shifted to that of morbidity reduction. Acute kidney injury adversely impact outcomes of patients following surgery for congenital heart disease as well as in those with heart failure (cardiorenal syndrome). Patients who become fluid overloaded and/or require dialysis are at a higher risk of mortality, but even minor degrees of acute kidney injury portend a significant increase in mortality and morbidity. Clinicians continue to seek methods of early diagnosis and risk stratification of acute kidney injury to prevent its adverse sequelae.

1Department of Pediatrics, Section of Cardiology, University of Cincinnati College of Medicine, Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

2Department of Pediatrics, Section of Cardiology, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Palo Alto, CA.

3Department of Pediatrics, Section of Nephrology, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

4Department of Pediatrics, Section of Cardiology, Stanford University School of Medicine, Cardiac Intensive Care Unit, Lucile Packard Children’s Hospital Palo Alto, CA.

Dr. Cooper received funding from Bo Bolus. His institution received funding from Grifols. Dr. Krawczeski received funding from Stanford University (Employment). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: David.Cooper@cchmc.org

Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies