LAUSR

Although the role of acute kidney injury (AKI) in the adult patient population in determining outcomes following acute illnesses has been progressively recognized, extensive research on the pediatric population has also indicated the incidence and impact of AKI among children with acute illnesses. The progress in pediatric AKI has been vast and often affected kidney care not only in the pediatric population but also in the care of the adult patients who are at risk of AKI or deal with AKI or its consequences. The progress in pediatric AKI care includes but is not limited to developing a consensus AKI definition, investigations related to epidemiology, pathophysiology, and risk factors of AKI among children, implementation of quality improvement projects with clinical benefits in saving lives, and the invention of new technologies to provide adequate dialysis to infants and children with a variable volume of distributions. As a not-for-profit organization, the Acute Disease Quality Initiative (ADQI) has been the origin of many advances in the awareness, recognition, and management of AKI and acute dialysis. ADQI has held 28 consensus conferences focusing on differing aspects of AKI care, providing an objective summary of the literature to describe the current state of key AKI-related topics among acutely ill patients. The ADQI reports have led to substantial progress not only in clinical settings but also in research realms.1 Considering advances in pediatric AKI and dialysis, a dedicated pediatric ADQI was long overdue. Therefore, the 26th ADQI was dedicated to the pediatric AKI topic with the participation of 47 multidisciplinary experts, including nephrology, critical care, and pharmacy in neonatal, pediatric, and adult age ranges. Goldstein and colleagues2 summarize the consensus statements during the 26th ADQI meeting. This meeting was structured in 6 distinct groups focused on different aspects of AKI among children. The first group emphasized critical aspects of pediatric AKI epidemiology, including studies to understand AKI risk factors (inherent, social, economic, and cultural factors), exposures leading to AKI consisting of the underlying diseases, management strategies, and outcomes (recovery, chronic diseases, and need for long-term dialysis).3 An important message of this group is that disparity exists in reporting the pediatric AKI epidemiology between intensive care units vs other settings (hospitals and communities) or resource-rich vs resource-limited areas. As the epidemiology reports can set the agenda for resource allocation, understanding the AKI incidence, causes, and outcomes may help persuade clinicians, policy makers, and governments to redirect facilities to AKI as a significant health crisis. The second group highlighted the value of appropriate risk-stratification and timely diagnosis of AKI. The concept of kidney fitness assessment before exposure using clinical and automated models or biomarkers was underscored by this group. Using a combination of kidney injury and function biomarkers to distinguish between functional vs structural AKI and its impact on clinical management and outcomes is discussed. In addition, the group endorsed the idea of approaching AKI as a syndrome with the need for appropriate phenotyping for individualized management strategies. This aim could be achieved through clinical data and models (logistic or machine learning models) and could be enhanced or confirmed with laboratory evaluations using urine or plasma kidney function or injury biomarkers, inflammation markers, urine examination, imaging techniques, and even kidney biopsy.4 + Related article