Starr Michelle C, Barreto Erin, Charlton Jennifer, Vega Molly, Brophy Patrick D, Ray Bignall O N, Sutherland Scott M, Menon Shina, Devarajan Prasad, Akcan Arikan Ayse, Basu Rajit, Goldstein Stuart, Soranno Danielle E
Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Riley Hospital for Children, 1044 W. Walnut Street, Indianapolis, IN, 46202, USA.
Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Pediatr Nephrol. 2024 Mar;39(3):941-953. doi: 10.1007/s00467-023-06154-y. Epub 2023 Oct 4.
In the past decade, there have been substantial advances in our understanding of the pathobiology of pediatric acute kidney injury (AKI). In particular, animal models and studies focused on the relationship between kidney development, nephron number, and kidney health have identified a number of heterogeneous pathophysiologies underlying AKI. Despite this progress, gaps remain in our understanding of the pathobiology of pediatric AKI.
During the 26th Acute Disease Quality Initiative (ADQI) Consensus conference, a multidisciplinary group of experts discussed the evidence and used a modified Delphi process to achieve consensus on recommendations for opportunities to advance translational research in pediatric AKI. The current state of research understanding as well as gaps and opportunities for advancement in research was discussed, and recommendations were summarized.
Consensus was reached that to improve translational pediatric AKI advancements, diverse teams spanning pre-clinical to epidemiological scientists must work in concert together and that results must be shared with the community we serve with patient involvement. Public and private research support and meaningful partnerships with adult research efforts are required. Particular focus is warranted to investigate the pediatric nuances of AKI, including the effect of development as a biological variable on AKI incidence, severity, and outcomes.
Although AKI is common and associated with significant morbidity, the biologic basis of the disease spectrum throughout varying nephron developmental stages remains poorly understood. An incomplete understanding of factors contributing to kidney health, the diverse pathobiologies underlying AKI in children, and the historically siloed approach to research limit advances in the field. The recommendations outlined herein identify gaps and outline a strategic approach to advance the field of pediatric AKI via multidisciplinary translational research.
在过去十年中，我们对儿童急性肾损伤（AKI）的病理生物学的理解有了实质性进展。特别是，专注于肾脏发育、肾单位数量和肾脏健康之间关系的动物模型和研究已经确定了AKI背后的一些异质性病理生理学。尽管取得了这一进展，但我们对儿童AKI病理生物学的理解仍存在差距。
在第26届急性疾病质量倡议（ADQI）共识会议期间，一个多学科专家小组讨论了证据，并采用改良的德尔菲法就推进儿童AKI转化研究机会的建议达成共识。讨论了研究理解的现状以及研究进展中的差距和机会，并总结了建议。
达成的共识是，为了改善儿童AKI的转化进展，从临床前到流行病学科学家的不同团队必须共同协作，并且结果必须在患者参与的情况下与我们所服务的社区共享。需要公共和私人研究支持以及与成人研究工作建立有意义的伙伴关系。特别值得关注的是研究AKI的儿童细微差别，包括发育作为一个生物学变量对AKI发病率、严重程度和结局的影响。
尽管AKI很常见且与显著的发病率相关，但在不同肾单位发育阶段整个疾病谱的生物学基础仍知之甚少。对影响肾脏健康的因素、儿童AKI背后的多种病理生物学以及历史上孤立的研究方法的不完全理解限制了该领域的进展。本文概述的建议确定了差距，并概述了通过多学科转化研究推进儿童AKI领域的战略方法。
