Pande Chetna K, Smith Mallory B, Soranno Danielle E, Gist Katja M, Fuhrman Dana Y, Dolan Kristin, Conroy Andrea L, Akcan-Arikan Ayse
Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA, United States.
Front Pediatr. 2022 Jun 30;10:893993. doi: 10.3389/fped.2022.893993. eCollection 2022.
Preclinical models and emerging translational data suggest that acute kidney injury (AKI) has far reaching effects on all other major organ systems in the body. Common in critically ill children and adults, AKI is independently associated with worse short and long term morbidity, as well as mortality, in these vulnerable populations. Evidence exists in adult populations regarding the impact AKI has on life course. Recently, non-renal organ effects of AKI have been highlighted in pediatric AKI survivors. Given the unique pediatric considerations related to somatic growth and neurodevelopmental consequences, pediatric AKI has the potential to fundamentally alter life course outcomes. In this article, we highlight the challenging and complex interplay between AKI and the brain, heart, lungs, immune system, growth, functional status, and longitudinal outcomes. Specifically, we discuss the biologic basis for how AKI may contribute to neurologic injury and neurodevelopment, cardiac dysfunction, acute lung injury, immunoparalysis and increased risk of infections, diminished somatic growth, worsened functional status and health related quality of life, and finally the impact on young adult health and life course outcomes.
临床前模型和新出现的转化数据表明，急性肾损伤（AKI）对身体所有其他主要器官系统都有深远影响。AKI在重症儿童和成人中很常见，在这些脆弱人群中，它与短期和长期的更差发病率以及死亡率独立相关。在成人人群中存在关于AKI对生命历程影响的证据。最近，AKI对非肾脏器官的影响在儿科AKI幸存者中得到了强调。鉴于与躯体生长和神经发育后果相关的独特儿科考量，儿科AKI有可能从根本上改变生命历程结局。在本文中，我们强调了AKI与大脑、心脏、肺、免疫系统、生长、功能状态和纵向结局之间具有挑战性和复杂性的相互作用。具体而言，我们讨论了AKI可能导致神经损伤和神经发育、心脏功能障碍、急性肺损伤、免疫麻痹和感染风险增加、躯体生长受限、功能状态恶化以及与健康相关的生活质量下降的生物学基础，最后讨论了对年轻成年人健康和生命历程结局的影响。
