Acute Kidney Injury and Renal Replacement Therapy in Immunocompromised Children

  • Joseph AngeloEmail author
  • Ayse A. Arikan


Acute kidney injury (AKI) occurs commonly in immunocompromised children with cancer and has a significant impact on morbidity and mortality. Early identification of patients at risk is of critical importance so that targeted and effective management can be implemented. While therapy for AKI remains mainly supportive, recent progress in the science of AKI has allowed for advancement in the diagnosis and treatment of AKI. Caring for critically ill children with AKI requires a multidisciplinary approach with input from all practitioners. With further innovation in the application of current therapies and the development of new treatment modalities, survival for children with cancer will continue to improve.


Acute kidney injury Cancer Children Renal replacement therapy 


  1. 1.
    Kaddourah A, et al. Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med. 2017;376(1):11–20.CrossRefGoogle Scholar
  2. 2.
    Kellum JA, et al. Developing a consensus classification system for acute renal failure. Curr Opin Crit Care. 2002;8(6):509–14.CrossRefGoogle Scholar
  3. 3.
    Akcan-Arikan A, et al. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71(10):1028–35.CrossRefGoogle Scholar
  4. 4.
    Mehta RL, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.CrossRefGoogle Scholar
  5. 5.
    Alkandari O, et al. Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study. Crit Care. 2011;15(3):R146.CrossRefGoogle Scholar
  6. 6.
    Zappitelli M, et al. A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney Int. 2009;76(8):885–92.CrossRefGoogle Scholar
  7. 7.
    Sanchez-Pinto LN, et al. Association between progression and improvement of acute kidney injury and mortality in critically ill children. Pediatr Crit Care Med. 2015;16(8):703–10.CrossRefGoogle Scholar
  8. 8.
    Devarajan P. Emerging biomarkers of acute kidney injury. In: Ronco C, Bellomo R, Kellum JA, editors. Acute kidney injury. Basel: Karger Publishers; 2007. p. 203–12.CrossRefGoogle Scholar
  9. 9.
    Samuels J, et al. Small increases in serum creatinine are associated with prolonged ICU stay and increased hospital mortality in critically ill patients with cancer. Support Care Cancer. 2011;19(10):1527–32.CrossRefGoogle Scholar
  10. 10.
    Chertow GM, et al. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16(11):3365–70.CrossRefGoogle Scholar
  11. 11.
    Volpon LC, Sugo EK, Carlotti AP. Diagnostic and prognostic value of serum cystatin C in critically ill children with acute kidney injury. Pediatr Crit Care Med. 2015;16(5):e125–31.CrossRefGoogle Scholar
  12. 12.
    Safdar OY, et al. Serum cystatin is a useful marker for the diagnosis of acute kidney injury in critically ill children: prospective cohort study. BMC Nephrol. 2016;17(1):130.CrossRefGoogle Scholar
  13. 13.
    Inker LA, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012;367(1):20–9.CrossRefGoogle Scholar
  14. 14.
    Al-Tonbary YA, et al. Pretreatment cystatin C in children with malignancy: can it predict chemotherapy-induced glomerular filtration rate reduction during the induction phase? J Pediatr Hematol Oncol. 2004;26(6):336–41.CrossRefGoogle Scholar
  15. 15.
    Barnfield MC, et al. Cystatin C in assessment of glomerular filtration rate in children and young adults suffering from cancer. Nucl Med Commun. 2013;34(6):609–14.CrossRefGoogle Scholar
  16. 16.
    Whiting P, et al. Accuracy of cystatin C for the detection of abnormal renal function in children undergoing chemotherapy for malignancy: a systematic review using individual patient data. Support Care Cancer. 2017:1–10.Google Scholar
  17. 17.
    Nguyen MT, Devarajan P. Biomarkers for the early detection of acute kidney injury. Pediatr Nephrol. 2008;23(12):2151.CrossRefGoogle Scholar
  18. 18.
    Sterling M, et al. Urine biomarkers of acute kidney injury in noncritically ill, hospitalized children treated with chemotherapy. Pediatr Blood Cancer. 2017;64(10)CrossRefGoogle Scholar
  19. 19.
    Basu RK, et al. Incorporation of biomarkers with the renal angina index for prediction of severe AKI in critically ill children. Clin J Am Soc Nephrol. 2014;9(4):654–62.CrossRefGoogle Scholar
  20. 20.
    Bihorac A, et al. Validation of cell-cycle arrest biomarkers for acute kidney injury using clinical adjudication. Am J Respir Crit Care Med. 2014;189(8):932–9.CrossRefGoogle Scholar
  21. 21.
    Meersch M, et al. Validation of cell-cycle arrest biomarkers for acute kidney injury after pediatric cardiac surgery. PLoS One. 2014;9(10):e110865.CrossRefGoogle Scholar
  22. 22.
    Fortenberry JD, Paden ML, Goldstein SL. Acute kidney injury in children: an update on diagnosis and treatment. Pediatr Clin. 2013;60(3):669–88.CrossRefGoogle Scholar
  23. 23.
    Plötz FB, et al. Effect of acute renal failure on outcome in children with severe septic shock. Pediatr Nephrol. 2005;20(8):1177–81.CrossRefGoogle Scholar
  24. 24.
    Michael M, Kuehnle I, Goldstein SL. Fluid overload and acute renal failure in pediatric stem cell transplant patients. Pediatr Nephrol. 2004;19(1):91–5.CrossRefGoogle Scholar
  25. 25.
    Sutherland SM, et al. AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol. 2015;10(4):554–61.CrossRefGoogle Scholar
  26. 26.
    Hui-Stickle S, Brewer ED, Goldstein SL. Pediatric ARF epidemiology at a tertiary care center from 1999 to 2001. Am J Kidney Dis. 2005;45(1):96–101.CrossRefGoogle Scholar
  27. 27.
    Koh K-N, et al. Acute kidney injury in pediatric patients receiving allogeneic hematopoietic cell transplantation: incidence, risk factors, and outcomes. Biol Blood Marrow Transplant. 2018;24(4):758–64.CrossRefGoogle Scholar
  28. 28.
    Hingorani S. Renal complications of hematopoietic-cell transplantation. N Engl J Med. 2016;374(23):2256–67.CrossRefGoogle Scholar
  29. 29.
    Selewski DT, et al. Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population. Intensive Care Med. 2014;40(10):1481–8.CrossRefGoogle Scholar
  30. 30.
    Raina R, et al. Hematopoietic stem cell transplantation and acute kidney injury in children: A comprehensive review. Pediatr Transplant. 2017;21(4):e12935.CrossRefGoogle Scholar
  31. 31.
    Krishnappa V, et al. Acute kidney injury in hematopoietic stem cell transplantation: a review. Int J Nephrol. 2016;2016:5163789.CrossRefGoogle Scholar
  32. 32.
    Mori J, et al. Risk assessment for acute kidney injury after allogeneic hematopoietic stem cell transplantation based on Acute Kidney Injury Network criteria. Intern Med. 2012;51(16):2105–10.CrossRefGoogle Scholar
  33. 33.
    Changsirikulchai S, et al. Renal thrombotic microangiopathy after hematopoietic cell transplant: role of GVHD in pathogenesis. Clin J Am Soc Nephrol. 2009;4(2):345–53.CrossRefGoogle Scholar
  34. 34.
    Laskin BL, et al. Small vessels, big trouble in the kidneys and beyond: hematopoietic stem cell transplantation–associated thrombotic microangiopathy. Blood. 2011;118(6):1452–62.CrossRefGoogle Scholar
  35. 35.
    Du Plessis L, Rassekh SR, Mammen C. High incidence of acute kidney injury during chemotherapy for childhood acute myeloid leukemia. Pediatr Blood Cancer. 2018;65(4):e26915.CrossRefGoogle Scholar
  36. 36.
    Fitzgerald JC, et al. Acute kidney injury in pediatric severe sepsis: an independent risk factor for death and new disability. Crit Care Med. 2016;44(12):2241–50.CrossRefGoogle Scholar
  37. 37.
    Foland JA, et al. Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med. 2004;32(8):1771–6.CrossRefGoogle Scholar
  38. 38.
    Arikan AA, et al. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med. 2012;13(3):253–8.CrossRefGoogle Scholar
  39. 39.
    Varghese SA, et al. Identification of diagnostic urinary biomarkers for acute kidney injury. J Investig Med. 2010;58(4):612–20.CrossRefGoogle Scholar
  40. 40.
    Arikan AA, et al. Resuscitation bundle in pediatric shock decreases acute kidney injury and improves outcomes. J Pediatr. 2015;167(6):1301–1305. e1.CrossRefGoogle Scholar
  41. 41.
    Tumlin JA, et al. Fenoldopam mesylate in early acute tubular necrosis: a randomized, double-blind, placebo-controlled clinical trial. Am J Kidney Dis. 2005;46(1):26–34.CrossRefGoogle Scholar
  42. 42.
    Goldstein SL, et al. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics. 2001;107(6):1309–12.CrossRefGoogle Scholar
  43. 43.
    Modem V, et al. Timing of continuous renal replacement therapy and mortality in critically ill children. Crit Care Med. 2014;42(4):943–53.CrossRefGoogle Scholar
  44. 44.
    Choi SJ, et al. Factors associated with mortality in continuous renal replacement therapy for pediatric patients with acute kidney injury. Pediatr Crit Care Med. 2017;18(2):e56–61.CrossRefGoogle Scholar
  45. 45.
    Goldstein SL, et al. Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int. 2005;67(2):653–8.CrossRefGoogle Scholar
  46. 46.
    Hackbarth R, et al. The effect of vascular access location and size on circuit survival in pediatric continuous renal replacement therapy: a report from the PPCRRT registry. Int J Artif Organs. 2007;30(12):1116–21.CrossRefGoogle Scholar
  47. 47.
    Fernández SN, et al. Citrate anticoagulation for CRRT in children: comparison with heparin. Biomed Res Int. 2014;2014:1–7.Google Scholar
  48. 48.
    Wu M-Y, et al. Regional citrate versus heparin anticoagulation for continuous renal replacement therapy: a meta-analysis of randomized controlled trials. Am J Kidney Dis. 2012;59(6):810–8.CrossRefGoogle Scholar
  49. 49.
    Asín-Prieto E, et al. Population pharmacokinetics of piperacillin and tazobactam in critically ill patients undergoing continuous renal replacement therapy: application to pharmacokinetic/pharmacodynamic analysis. J Antimicrob Chemother. 2013;69(1):180–9.CrossRefGoogle Scholar
  50. 50.
    Chaijamorn W, Wanakamanee U. Pharmacokinetics of vancomycin in critically ill patients undergoing continuous venovenous haemodialysis. Int J Antimicrob Agents. 2014;44(4):367–8.CrossRefGoogle Scholar
  51. 51.
    Veltri MA, et al. Drug dosing during intermittent hemodialysis and continuous renal replacement therapy. Pediatr Drugs. 2004;6(1):45–65.CrossRefGoogle Scholar
  52. 52.
    Sgambat K, Moudgil A. Carnitine deficiency in children receiving continuous renal replacement therapy. Hemodial Int. 2016;20(1):63–7.CrossRefGoogle Scholar
  53. 53.
    Knijnenburg SL, et al. Early and late renal adverse effects after potentially nephrotoxic treatment for childhood cancer. Cochrane Libr. 2013;(10):1–197.Google Scholar
  54. 54.
    Mulder RL, et al. Glomerular function time trends in long-term survivors of childhood cancer: a longitudinal study. Cancer Epidemiol Prev Biomarkers. 2013;22(10):1736–46.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing 2019

Authors and Affiliations

  1. 1.Department of Pediatrics, Renal SectionTexas Children’s Hospital/Baylor College of MedicineHoustonUSA
  2. 2.Renal Section, Critical Care SectionTexas Children’s Hospital/Baylor College of MedicineHoustonUSA

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