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Kidney Health After We Go Home

Why is it important to think about kidney health after going home from the hospital, even if AKI has resolved and kidney function is normal?

It is important to monitor kidney health during and after recovery from an acute kidney injury. This is because there is a relationship between acute kidney injury (AKI), a temporary issue, and development of chronic kidney disease (CKD), a long-term and irreversible condition. One major benefit of monitoring kidney health is to detect CKD early through monitoring. This early detection improves long-term kidney health outcomes. 

What is chronic kidney disease?

Chronic kidney disease, which is also sometimes referred to by its abbreviation CKD, describes a slow, progressive decrease in kidney function. CKD can be diagnosed either with:

  1. Decreased kidney function (based on blood testing of creatinine, cystatin C or other blood markers of kidney function) and/or
  2. Protein in the urine

Protein in the urine and changes in kidney function are both signs that your kidneys are not removing waste from your blood correctly. Like acute kidney injury, CKD patients may have decreased urination, high blood pressure, and swelling. Unlike acute kidney injury, CKD persists over time and is not reversible. The progression of CKD can be slowed down with medications, but it ultimately cannot be cured and may require dialysis and/or kidney transplant. 

How common is CKD in children that graduate from the NICU?

We don’t know for sure, but it appears to be common. Studies show that the risk of CKD is 2.5 times higher in children admitted to the NICU compared to those that are born full-term. This risk is even higher if children are born prematurely (<37 weeks gestation), small for gestational age or with intrauterine growth restriction, or in those who have kidney injury (AKI) during their admission. A recent study found that approximately 25% of premature neonates (<28 weeks) had high blood pressure or mild decreased kidney function as early as two years old. Studies have conflicting data about whether AKI increases the risk of chronic kidney dysfunction in children that graduate from the NICU. 

How would I know if CKD is developing?

CKD is a chronic and irreversible condition that often does not have symptoms until the disease is very advanced. The best way to detect CKD is developing is to talk to your care team about monitoring for it.

There are currently no expert or evidence-based guidelines on how to monitor for CKD after an episode of AKI. However, monitoring may include:

  • Blood pressure checks (to detect high blood pressure)
  • Urine testing (to check for protein) 
  • Blood testing (to check kidney function). 

Seeing a kidney doctor (nephrologist) may also be part of your care plan. 

Is there anything I can do after AKI to decrease the risk of CKD?

Hydrate, avoid NSAIDs (choose acetaminophen/Tylenol over ibuprofen/Motrin), attend regular follow-up appointments. It is important that you remind your care team that your child had an episode of AKI so that they can be aware and monitor. While there is currently no evidence-based guidance on how to monitor for CKD after an episode of AKI, sometimes monitoring may include blood pressure checks (to detect high blood pressure), urine testing (to check for protein) or blood testing (to check kidney function). Seeing a kidney doctor (nephrologist) may also be part of your care plan.