Acute kidney injury in pediatric heart transplantation and extracorporeal cardiac support therapies

Acute kidney injury occurs frequently and is associated with poor outcome in children with heart failure. More than fifty percent of children with heart failure and two-thirds of children on mechanical circulatory support have acute kidney injury. Injury severity is directly related to duration of mechanical ventilation, length of stay, and rate of mortality. The pathophysiology of AKI in the setting of cardiac disease in these patients is characterized by cardiorenal syndrome — a bidirectional constellation of symptoms describing the potential perturbations in cardiac–renal crosstalk. In this review, we will discuss the pathophysiology, epidemiology, management, and outcomes of acute kidney injury in pediatric patients with heart failure and requiring cardiac support therapies, specifically those with advanced heart failure, receiving extracorporeal membrane oxygenation, and using ventricular assist devices.