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The path to chronic kidney disease following acute kidney injury: a neonatal perspective

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Abstract

The risk of acute kidney injury (AKI) in hospitalized critically ill neonatal populations without primary renal disease continues to be high, in both term and premature infants. Observational studies have revealed high rates of chronic kidney disease (CKD) in survivors of neonatal AKI. Proposed mechanisms underlying the progression of CKD following AKI include nephron loss and hyperfiltration, vascular insufficiency and maladaptive repair mechanisms. Other factors, including prematurity and low birth weight, have an independent relationship with the development of CKD, but they may also be positive effect modifiers in the relationship of AKI and CKD. The large degree of heterogeneity in the literature on AKI in the neonatal population, including the use of various AKI definitions and CKD outcomes, has hampered the medical community’s ability to properly assess the relationship of AKI and CKD in this vulnerable population. Larger prospective cohort studies with control groups which utilize recently proposed neonatal AKI definitions and standardized CKD definitions are much needed to properly quantify the risk of CKD following an episode of AKI. Until there is further evidence to guide us, we recommend that all neonates with an identified episode of AKI should have an appropriate longitudinal follow-up in order to identify CKD at its earliest stages.

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Acknowledgements

We thank Dr. Dimple Rajgor for her assistance in reviewing and editing the manuscript.

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Authors and Affiliations

  1. Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore, Singapore

    Swasti Chaturvedi & Kar Hui Ng

  2. Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Kar Hui Ng

  3. Division of Paediatric Nephrology, Department of Paediatrics, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC, Canada, V6H3V4

    Cherry Mammen

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  1. Swasti Chaturvedi
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  2. Kar Hui Ng
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Correspondence to Cherry Mammen.

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2. b

3. e

4. c

5. e

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Chaturvedi, S., Ng, K.H. & Mammen, C. The path to chronic kidney disease following acute kidney injury: a neonatal perspective. Pediatr Nephrol 32, 227–241 (2017). https://doi.org/10.1007/s00467-015-3298-9

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