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Cardorenal syndrome: an emerging problem in pediatric critical care

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An Erratum to this article was published on 11 January 2013

Abstract

The cardiorenal syndrome (CRS) refers to a complex pathophysiologic state in which heart and kidney dysfunction coexist. Although a robust amount of adult literature exists, limited reports have been made regarding CRS in pediatric patients. However, CRS is increasingly being recognized as an impactful clinical problem that can have important implications regarding the need for treatment and prognosis. Although wide acceptance of a unified definition of CRS is lacking, a general consensus exists that CRS can be either primarily caused by cardiac disease with secondary effects on the kidney, or vice versa, as well as systemic conditions in which cardiac and renal disease are both considered to be secondary. Convincing data in the pediatric perioperative population have been reported, but there is a paucity of information in acute and chronic heart failure (HF), as well as acute kidney injury (AKI) and chronic kidney disease (CKD). Herein, we briefly report on the adult literature and summarize the current pediatric experience.

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References

  1. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, Carnethon MR, Dai S, de Simone G, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Greenlund KJ, Hailpern SM, Heit JA, Ho PM, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, McDermott MM, Meigs JB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Rosamond WD, Sorlie PD, Stafford RS, Turan TN, Turner MB, Wong ND, Wylie-Rosett J, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2011) Heart disease and stroke statistics–2011 update: a report from the American Heart Association. Circulation 123:e18–e209

    Article  PubMed  Google Scholar 

  2. Rossano JW, Kim JJ, Decker JA, Price JF, Zafar F, Graves DE, Morales DL, Heinle JS, Bozkurt B, Towbin JA, Denfield SW, Dreyer WJ, Jefferies JL (2012) Prevalence, morbidity, and mortality of heart failure-related hospitalizations in children in the United States: a population-based study. J Card Fail 18:459–470

    Article  PubMed  Google Scholar 

  3. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2012) Heart disease and stroke statistics–2012 update: a report from the American Heart Association. Circulation 125:e2–e220

    Article  PubMed  Google Scholar 

  4. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Roger VL, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2010) Heart disease and stroke statistics–2010 update: a report from the American Heart Association. Circulation 121:e46–e215

    Article  PubMed  Google Scholar 

  5. Law SP, Kim JJ, Decker JA, Price JF, Cabrera AG, Graves DE, Morales DL, Heinle JS, Denfield SW, Dreyer WJ, Rossano JW (2012) Hospital charges for pediatric heart transplant hospitalizations in the United States from 1997 to 2006. J Heart Lung Transplant 31:485–491

    Article  PubMed  Google Scholar 

  6. Levy WC, Mozaffarian D, Linker DT, Sutradhar SC, Anker SD, Cropp AB, Anand I, Maggioni A, Burton P, Sullivan MD, Pitt B, Poole-Wilson PA, Mann DL, Packer M (2006) The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation 113:1424–1433

    Article  PubMed  Google Scholar 

  7. Fonarow GC (2008) Epidemiology and risk stratification in acute heart failure. Am Heart J 155:200–207

    Article  PubMed  Google Scholar 

  8. Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV (2003) Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA 290:2581–2587

    Article  PubMed  CAS  Google Scholar 

  9. Fonarow GC, Adams KF Jr, Abraham WT, Yancy CW, Boscardin WJ (2005) Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA 293:572–580

    Article  PubMed  CAS  Google Scholar 

  10. O'Connor CM, Hasselblad V, Mehta RH, Tasissa G, Califf RM, Fiuzat M, Rogers JG, Leier CV, Stevenson LW (2010) Triage after hospitalization with advanced heart failure: the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) risk model and discharge score. J Am Coll Cardiol 55:872–878

    Article  PubMed  Google Scholar 

  11. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R (2008) Cardiorenal syndrome. J Am Coll Cardiol 52:1527–1539

    Article  PubMed  Google Scholar 

  12. Bagshaw SM, Cruz DN, Aspromonte N, Daliento L, Ronco F, Sheinfeld G, Anker SD, Anand I, Bellomo R, Berl T, Bobek I, Davenport A, Haapio M, Hillege H, House A, Katz N, Maisel A, Mankad S, McCullough P, Mebazaa A, Palazzuoli A, Ponikowski P, Shaw A, Soni S, Vescovo G, Zamperetti N, Zanco P, Ronco C, Acute Dialysis Quality Initiative Consensus Group (2010) Epidemiology of cardio-renal syndromes: workgroup statements from the 7th ADQI Consensus Conference. Nephrol Dial Transplant 25:1406–1416

    Article  PubMed  Google Scholar 

  13. Metra M, Davison B, Bettari L, Sun H, Edwards C, Lazzarini V, Piovanelli B, Carubelli V, Bugatti S, Lombardi C, Cotter G, Dei Cas L (2012) Is worsening renal function an ominous prognostic sign in patients with acute heart failure? The role of congestion and its interaction with renal function. Circ Heart Fail 5:54–62

    Article  PubMed  Google Scholar 

  14. Haddad F, Fuh E, Peterson T, Skhiri M, Kudelko KT, De Jesus PV, Winkelmayer WC, Doyle RL, Chertow GM, Zamanian RT (2011) Incidence, correlates, and consequences of acute kidney injury in patients with pulmonary arterial hypertension hospitalized with acute right-side heart failure. J Card Fail 17:533–539

    Article  PubMed  Google Scholar 

  15. Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, Young JB, Tang WH (2009) Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 53:589–596

    Article  PubMed  Google Scholar 

  16. Price JF, Mott AR, Dickerson HA, Jefferies JL, Nelson DP, Chang AC, O'Brian Smith E, Towbin JA, Dreyer WJ, Denfield SW, Goldstein SL (2008) Worsening renal function in children hospitalized with decompensated heart failure: evidence for a pediatric cardiorenal syndrome? Pediatr Crit Care Med 9:279–284

    Article  PubMed  Google Scholar 

  17. Lok CE, Austin PC, Wang H, Tu JV (2004) Impact of renal insufficiency on short- and long-term outcomes after cardiac surgery. Am Heart J 148:430–438

    Article  PubMed  Google Scholar 

  18. Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, Ruff SM, Zahedi K, Shao M, Bean J, Mori K, Barasch J, Devarajan P (2005) Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 365:1231–1238

    Article  PubMed  CAS  Google Scholar 

  19. Blinder JJ, Goldstein SL, Lee VV, Baycroft A, Fraser CD, Nelson D, Jefferies JL (2012) Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 143:368–374

    Article  PubMed  Google Scholar 

  20. Krawczeski CD, Goldstein SL, Woo JG, Wang Y, Piyaphanee N, Ma Q, Bennett M, Devarajan P (2011) Temporal relationship and predictive value of urinary acute kidney injury biomarkers after pediatric cardiopulmonary bypass. J Am Coll Cardiol 58:2301–2309

    Article  PubMed  CAS  Google Scholar 

  21. Sorof JM, Stromberg D, Brewer ED, Feltes TF, Fraser CD Jr (1999) Early initiation of peritoneal dialysis after surgical repair of congenital heart disease. Pediatr Nephrol 13:641–645

    Article  PubMed  CAS  Google Scholar 

  22. Costanzo MR, Guglin ME, Saltzberg MT, Jessup ML, Bart BA, Teerlink JR, Jaski BE, Fang JC, Feller ED, Haas GJ, Anderson AS, Schollmeyer MP, Sobotka PA, Trial Investigators UNLOAD (2007) Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 49:675–683

    Article  PubMed  CAS  Google Scholar 

  23. Bart BA, Goldsmith SR, Lee KL, Redfield MM, Felker GM, O'Connor CM, Chen HH, Rouleau JL, Givertz MM, Semigran MJ, Mann D, Deswal A, Bull DA, Lewinter MM, Braunwald E (2012) Cardiorenal Rescue Study in Acute Decompensated Heart Failure: Rationale and Design of CARRESS-HF, for the Heart Failure Clinical Research Network. J Card Fail 18:176–182

    Article  PubMed  Google Scholar 

  24. Hillege HL, Nitsch D, Pfeffer MA, Swedberg K, McMurray JJ, Yusuf S, Granger CB, Michelson EL, Ostergren J, Cornel JH, de Zeeuw D, Pocock S, van Veldhuisen DJ, Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Investigators (2006) Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation 113:671–678

    Article  PubMed  Google Scholar 

  25. Heywood JT, Fonarow GC, Costanzo MR, Mathur VS, Wigneswaran JR, Wynne J (2007) High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Card Fail 13:422–430

    Article  PubMed  Google Scholar 

  26. Klein L, Massie BM, Leimberger JD, O'Connor CM, Piña IL, Adams KF Jr, Califf RM, Gheorghiade M, Investigators OPTIME-CHF (2008) Admission or changes in renal function during hospitalization for worsening heart failure predict postdischarge survival: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF). Circ Heart Fail 1:25–33

    Article  PubMed  CAS  Google Scholar 

  27. Dries DL, Exner DV, Domanski MJ, Greenberg B, Stevenson LW (2000) The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol 35:681–689

    Article  PubMed  CAS  Google Scholar 

  28. Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, Konstam MA, Mancini DM, Rahko PS, Silver MA, Stevenson LW, Yancy CW (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119:1977–2016

    Article  PubMed  Google Scholar 

  29. Domanski M, Norman J, Pitt B, Haigney M, Hanlon S, Peyster E (2003) Diuretic use, progressive heart failure, and death in patients in the Studies Of Left Ventricular Dysfunction (SOLVD). J Am Coll Cardiol 42:705–708

    Article  PubMed  CAS  Google Scholar 

  30. Testani JM, Cappola TP, Brensinger CM, Shannon RP, Kimmel SE (2011) Interaction between loop diuretic-associated mortality and blood urea nitrogen concentration in chronic heart failure. J Am Coll Cardiol 58:375–382

    Article  PubMed  CAS  Google Scholar 

  31. Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C (2006) An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 34:1913–1917

    Article  PubMed  Google Scholar 

  32. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL (2007) Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 71:1028–1035

    Article  PubMed  CAS  Google Scholar 

  33. Olowu WA (2011) Acute childhood cardiorenal syndrome and impact of cardiovascular morbidity on survival. Int J Nephrol 2011:412495

    PubMed  Google Scholar 

  34. Shlipak MG, Lash JP, Yang W, Teal V, Keane M, Cappola T, Keller C, Jamerson K, Kusek J, Delafontaine P, He J, Miller ER 3rd, Schreiber M, Go AS, Investigators CRIC (2011) Symptoms characteristic of heart failure among CKD patients without diagnosed heart failure. J Card Fail 17:17–23

    Article  PubMed  Google Scholar 

  35. Mitsnefes MM (2012) Cardiovascular disease in children with chronic kidney disease. J Am Soc Nephrol 23:578–585

    Article  PubMed  CAS  Google Scholar 

  36. Flynn JT, Mitsnefes M, Pierce C, Cole SR, Parekh RS, Furth SL, Warady BA, Chronic Kidney Disease in Children Study Group (2008) Blood pressure in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children study. Hypertension 52:631–637

    Article  PubMed  CAS  Google Scholar 

  37. Wilson AC, Schneider MF, Cox C, Greenbaum LA, Saland J, White CT, Furth S, Warady BA, Mitsnefes MM (2011) Prevalence and correlates of multiple cardiovascular risk factors in children with chronic kidney disease. Clin J Am Soc Nephrol 6:2759–2765

    Article  PubMed  CAS  Google Scholar 

  38. Chavers BM, Li S, Collins AJ, Herzog CA (2002) Cardiovascular disease in pediatric chronic dialysis patients. Kidney Int 62:648–653

    Article  PubMed  Google Scholar 

  39. Sarnak MJ, Levey AS (2000) Cardiovascular disease and chronic renal disease: a new paradigm. Am J Kidney Dis 35:S117–S131

    Article  PubMed  CAS  Google Scholar 

  40. Srivaths PR, Silverstein DM, Leung J, Krishnamurthy R, Goldstein SL (2010) Malnutrition-inflammation-coronary calcification in pediatric patients receiving chronic hemodialysis. Hemodial Int 14:263–269

    Article  PubMed  Google Scholar 

  41. Shroff RC, Donald AE, Hiorns MP, Watson A, Feather S, Milford D, Ellins EA, Storry C, Ridout D, Deanfield J, Rees L (2007) Mineral metabolism and vascular damage in children on dialysis. J Am Soc Nephrol 18:2996–3003

    Article  PubMed  CAS  Google Scholar 

  42. Wang AY, Woo J, Wang M, Sea MM, Ip R, Li PK, Lui SF, Sanderson JE (2001) Association of inflammation and malnutrition with cardiac valve calcification in continuous ambulatory peritoneal dialysis patients. J Am Soc Nephrol 12:1927–1936

    PubMed  CAS  Google Scholar 

  43. Civilibal M, Caliskan S, Kurugoglu S, Candan C, Canpolat N, Sever L, Kasapcopur O, Arisoy N (2009) Progression of coronary calcification in pediatric chronic kidney disease stage 5. Pediatr Nephrol 24:555–563

    Article  PubMed  Google Scholar 

  44. Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, Krumholz HM (2006) Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol 47:1987–1996

    Article  PubMed  Google Scholar 

  45. Nohria A, Hasselblad V, Stebbins A, Pauly DF, Fonarow GC, Shah M, Yancy CW, Califf RM, Stevenson LW, Hill JA (2008) Cardiorenal interactions: insights from the ESCAPE trial. J Am Coll Cardiol 51:1268–1274

    Article  PubMed  Google Scholar 

  46. Moran A, Katz R, Smith NL, Fried LF, Sarnak MJ, Seliger SL, Psaty B, Siscovick DS, Gottdiener JS, Shlipak MG (2008) Cystatin C concentration as a predictor of systolic and diastolic heart failure. J Card Fail 14:19–26

    Article  PubMed  CAS  Google Scholar 

  47. Srisawasdi P, Vanavanan S, Charoenpanichkit C, Kroll MH (2010) The effect of renal dysfunction on BNP, NT-proBNP, and their ratio. Am J Clin Pathol 133:14–23

    Article  PubMed  CAS  Google Scholar 

  48. DeFilippi C, van Kimmenade RR, Pinto YM (2008) Amino-terminal pro-B-type natriuretic peptide testing in renal disease. Am J Cardiol 101:82–88

    Article  PubMed  Google Scholar 

  49. Hui-Stickle S, Brewer ED, Goldstein SL (2005) Pediatric ARF epidemiology at a tertiary care center from 1999 to 2001. Am J Kidney Dis 45:96–101

    Article  PubMed  Google Scholar 

  50. Askenazi DJ, Feig DI, Graham NM, Hui-Stickle S, Goldstein SL (2006) 3-5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int 69:184–189

    Article  PubMed  CAS  Google Scholar 

  51. Mammen C, Al Abbas A, Skippen P, Nadel H, Levine D, Collet JP, Matsell DG (2012) Long-term Risk of CKD in Children Surviving Episodes of Acute Kidney Injury in the Intensive Care Unit: A Prospective Cohort Study. Am J Kidney Dis 59:523–530

    Article  PubMed  Google Scholar 

  52. Cunningham PN, Dyanov HM, Park P, Wang J, Newell KA, Quigg RJ (2002) Acute renal failure in endotoxemia is caused by TNF acting directly on TNF receptor-1 in kidney. J Immunol 168:5817–5823

    PubMed  CAS  Google Scholar 

  53. Kumar A, Paladugu B, Mensing J, Parrillo JE (2007) Nitric oxide-dependent and -independent mechanisms are involved in TNF-alpha-induced depression of cardiac myocyte contractility. Am J Physiol Regul Integr Comp Physiol 292:R1900–R1906

    Article  PubMed  CAS  Google Scholar 

  54. Thakar CV, Christianson A, Freyberg R, Almenoff P, Render ML (2009) Incidence and outcomes of acute kidney injury in intensive care units: a Veterans Administration study. Crit Care Med 37:2552–2558

    Article  PubMed  Google Scholar 

  55. Srisawat N, Hoste EE, Kellum JA (2010) Modern classification of acute kidney injury. Blood Purif 29:300–307

    Article  PubMed  Google Scholar 

  56. Goldstein SL (2011) Acute kidney injury biomarkers: renal angina and the need for a renal troponin I. BMC Med 9:135

    Article  PubMed  Google Scholar 

  57. Shaw A (2012) Update on acute kidney injury after cardiac surgery. J Thorac Cardiovasc Surg 143:676–681

    Article  PubMed  Google Scholar 

  58. Goldstein SL, Chawla LS (2010) Renal angina. Clin J Am Soc Nephrol 5:943–949

    Article  PubMed  Google Scholar 

  59. Ricci Z, Luciano R, Favia I, Garisto C, Muraca M, Morelli S, Di Chiara L, Cogo P, Picardo S (2011) High-dose fenoldopam reduces postoperative neutrophil gelatinase-associated lipocalin and cystatin C levels in pediatric cardiac surgery. Crit Care 15:R160

    Article  PubMed  Google Scholar 

  60. Zappitelli M, Bernier PL, Saczkowski RS, Tchervenkov CI, Gottesman R, Dancea A, Hyder A, Alkandari O (2009) A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney Int 76:885–892

    Article  PubMed  CAS  Google Scholar 

  61. Dent CL, Ma Q, Dastrala S, Bennett M, Mitsnefes MM, Barasch J, Devarajan P (2007) Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort study. Crit Care 11:R127

    Article  PubMed  Google Scholar 

  62. Bennett M, Dent CL, Ma Q, Dastrala S, Grenier F, Workman R, Syed H, Ali S, Barasch J, Devarajan P (2008) Urine NGAL predicts severity of acute kidney injury after cardiac surgery: a prospective study. Clin J Am Soc Nephrol 3:665–673

    Article  PubMed  Google Scholar 

  63. Xin C, Yulong X, Yu C, Changchun C, Feng Z, Xinwei M (2008) Urine neutrophil gelatinase-associated lipocalin and interleukin-18 predict acute kidney injury after cardiac surgery. Ren Fail 30:904–913

    Article  PubMed  Google Scholar 

  64. Parikh CR, Devarajan P, Zappitelli M, Sint K, Thiessen-Philbrook H, Li S, Kim RW, Koyner JL, Coca SG, Edelstein CL, Shlipak MG, Garg AX, Krawczeski CD, TRIBE-AKI Consortium (2011) Postoperative Biomarkers Predict Acute Kidney Injury and Poor Outcomes after Pediatric Cardiac Surgery. J Am Soc Nephrol 22:1737–1747

    Article  PubMed  CAS  Google Scholar 

  65. Parikh CR, Mishra J, Thiessen-Philbrook H, Dursun B, Ma Q, Kelly C, Dent C, Devarajan P, Edelstein CL (2006) Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney Int 70:199–203

    Article  PubMed  CAS  Google Scholar 

  66. Krawczeski CD, Vandevoorde RG, Kathman T, Bennett MR, Woo JG, Wang Y, Griffiths RE, Devarajan P (2010) Serum cystatin C is an early predictive biomarker of acute kidney injury after pediatric cardiopulmonary bypass. Clin J Am Soc Nephrol 5:1552–1557

    Article  PubMed  CAS  Google Scholar 

  67. Zappitelli M, Krawczeski CD, Devarajan P, Wang Z, Sint K, Thiessen-Philbrook H, Li S, Bennett MR, Ma Q, Shlipak MG, Garg AX, Parikh CR, TRIBE-AKI consortium (2011) Early postoperative serum cystatin C predicts severe acute kidney injury following pediatric cardiac surgery. Kidney Int 80:655–662

    Article  PubMed  CAS  Google Scholar 

  68. Han WK, Waikar SS, Johnson A, Betensky RA, Dent CL, Devarajan P, Bonventre JV (2008) Urinary biomarkers in the early diagnosis of acute kidney injury. Kidney Int 73:863–869

    Article  PubMed  CAS  Google Scholar 

  69. Portilla D, Dent C, Sugaya T, Nagothu KK, Kundi I, Moore P, Noiri E, Devarajan P (2008) Liver fatty acid-binding protein as a biomarker of acute kidney injury after cardiac surgery. Kidney Int 73:465–472

    Article  PubMed  CAS  Google Scholar 

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  1. The Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH, 45243, USA

    John Lynn Jefferies

  2. Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, OH, USA

    Stuart L. Goldstein

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Jefferies, J.L., Goldstein, S.L. Cardorenal syndrome: an emerging problem in pediatric critical care. Pediatr Nephrol 28, 855–862 (2013). https://doi.org/10.1007/s00467-012-2251-4

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