Advances in pediatric acute kidney injury pathobiology: a report from the 26th Acute Disease Quality Initiative (ADQI) conference

Michelle C Starr; Erin Barreto; Jennifer Charlton; Molly Vega; Patrick D Brophy; O N Ray Bignall 2nd; Scott M Sutherland; Shina Menon; Prasad Devarajan; Ayse Akcan Arikan; Rajit Basu; Stuart Goldstein; Danielle E Soranno; ADQI 26 workgroup

doi:10.1007/s00467-023-06154-y

Advances in pediatric acute kidney injury pathobiology: a report from the 26th Acute Disease Quality Initiative (ADQI) conference

Pediatr Nephrol. 2024 Mar;39(3):941-953. doi: 10.1007/s00467-023-06154-y. Epub 2023 Oct 4.

Authors

Michelle C Starr^{1

2}, Erin Barreto³, Jennifer Charlton⁴, Molly Vega⁵, Patrick D Brophy⁶, O N Ray Bignall 2nd⁷, Scott M Sutherland⁸, Shina Menon⁹, Prasad Devarajan¹⁰, Ayse Akcan Arikan¹¹, Rajit Basu¹², Stuart Goldstein¹⁰, Danielle E Soranno^{13

14}; ADQI 26 workgroup

Affiliations

¹ Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Riley Hospital for Children, 1044 W. Walnut Street, Indianapolis, IN, 46202, USA.
² Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
³ Department of Pharmacy, Mayo Clinic, Rochester, MN, USA.
⁴ Department of Pediatrics, Division of Nephrology, University of Virginia, Charlottesville, VA, USA.
⁵ Renal and Apheresis Services, Texas Children's Hospital, Houston, TX, USA.
⁶ Department of Pediatrics, Golisano Children's Hospital, University of Rochester, Rochester, NY, USA.
⁷ Department of Pediatrics, Division of Nephrology and Hypertension, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA.
⁸ Department of Pediatrics, Division of Nephrology, Stanford University School of Medicine, Stanford, CA, USA.
⁹ Division of Pediatric Nephrology, Seattle Children's Hospital and University of Washington, Seattle, WA, USA.
¹⁰ Department of Pediatrics, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
¹¹ Department of Pediatrics, Divisions of Critical Care and Nephrology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
¹² Department of Pediatrics, Division of Critical Care, Northwestern University, Chicago, IL, USA.
¹³ Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Riley Hospital for Children, 1044 W. Walnut Street, Indianapolis, IN, 46202, USA. DSoranno@iu.edu.
¹⁴ Department of Bioengineering, Purdue University, West Lafayette, IN, USA. DSoranno@iu.edu.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Acute kidney injury; Animal models; Development as a biological variable; Neonates; Outcomes; Pediatrics; Translational research.

MeSH terms

Acute Disease
Acute Kidney Injury* / etiology
Acute Kidney Injury* / therapy
Adult
Animals
Child
Consensus
Humans
Incidence
Models, Animal