SECTION SHORT ANSWER
Advances and Answers in Pediatric Health
Demystifying Acute Kidney Injury
NEPHROLOGY
According to an international study of critically ill children , when a patient in the pediatric intensive care unit ( PICU ) develops severe acute kidney injury , or AKI , they are eight times more likely to die . For Erin Stenson , MD , that statistic — and the fact that more than 25 % of kids in the ICU develop AKI — has been a constant driver behind research that aims to identify the disease early and treat it with precision . She recently published a review ( 1 ) of existing knowledge on AKI and has a prospective pediatric study underway to examine this issue further .
Acute kidney injury can result from a variety of conditions that might put kids in the ICU , including trauma and respiratory failure . The most common cause though , Dr . Stenson says , is sepsis . When a child develops a bad infection leading to sepsis , the body relies on the immune system to kill bacteria and viruses . One component of this immune response is the complement system , which is normally highly regulated . But an overactive or dysregulated complement system can begin attacking and killing healthy cells as well . This tends to have a pronounced effect in the kidneys , sometimes leading to AKI .
Given this well-studied relationship between complement system activation and AKI in preclinical models , Dr . Stenson is working alongside Children ’ s Colorado nephrologist Brad Dixon , MD , and other colleagues at the University of Colorado to identify a complement system biomarker that could indicate elevated risk of AKI . Her current research is focused on factor B , a protein that amplifies activation of the complement system . This activation creates a byproduct in the urine , called complement factor Ba , that Dr . Stenson thinks could serve as a canary in the coal mine for AKI .
As part of this , Dr . Stenson is identifying urine Ba levels that signal
worse outcomes of AKI , with the long-term goal to trial novel therapeutics that inhibit factor B to treat AKI . This work is critical , as there are currently no treatments beyond supportive care for AKI , and even if a patient survives an episode of AKI , they are at increased risk for issues as adults .
“ If we can limit AKI episodes , we can limit chronic kidney disease and thus the need for dialysis or a kidney transplant as these patients age ,” Dr . Stenson explains . “ It could have a huge population impact in the future .” •
1 . Stenson , Erin K et al . “ The complement system in pediatric acute kidney injury .” Pediatric nephrology ( Berlin , Germany ) vol . 38,5 ( 2023 ): 1411-1425 . doi : 10.1007 / s00467-022-05755-3 .
ERIN STENSON , MD
Pediatric critical care , Children ’ s Hospital Colorado
Assistant professor , Pediatrics-Critical Care Medicine , University of Colorado School of Medicine
BRADLEY DIXON , MD
Section head , pediatric nephrology , Children ’ s Hospital Colorado
Associate professor , Pediatrics-Nephrology , University of Colorado School of Medicine