Our Summary

This study aimed to see if a certain test ([TIMP-2]*[IGFBP7] measured using NEPHROCHECK®) can help predict a kidney condition called acute kidney injury (AKI) in Chinese infants and small children who have complex heart surgery.

In the study, 230 patients had the test at eight different times around their surgery. Out of these, 50 patients (22%) developed moderate to severe AKI within three days of starting a type of treatment called cardiopulmonary bypass (CPB).

Patients who had a temporary increase in a substance called serum creatinine (SCr) within 24 hours did not have worse outcomes than patients with no or mild AKI. However, patients who had an increase in SCr after 24 hours, and patients who needed dialysis (a treatment to replace the function of the kidneys), did have worse outcomes.

The test showed a significant increase in [TIMP-2]*[IGFBP7] in patients with severe AKI at two, four, 12, and 24 hours after starting CPB. The ability of the test to predict severe AKI was highest at two hours (AUC = 0.76) and between two and 24 hours (AUC = 0.80).

Adding the NEPHROCHECK® test to the usual checks after surgery improved the prediction of severe AKI.

In conclusion, the study found that the test can predict severe AKI as early as two hours after starting CPB. However, it does not predict temporary AKI.

FAQs

  1. What is the purpose of the [TIMP-2]*[IGFBP7] test measured using NEPHROCHECK® in this study?
  2. How effective was the [TIMP-2]*[IGFBP7] test in predicting severe AKI in pediatric cardiac surgery patients?
  3. Can the [TIMP-2]*[IGFBP7] test predict temporary AKI in pediatric patients after cardiac surgery?

Doctor’s Tip

Therefore, it is important for pediatric cardiac surgery patients to have regular monitoring and early detection of any kidney complications, especially if they show signs of AKI after 24 hours or require dialysis. By incorporating the NEPHROCHECK® test into post-operative care, doctors can better predict and manage the risk of severe AKI in young patients undergoing complex heart surgery. Remember to follow your doctor’s recommendations and attend all follow-up appointments to ensure the best possible outcome for your child’s health.

Suitable For

Patients who are typically recommended pediatric cardiac surgery include infants and small children with complex heart conditions that require surgical intervention. These patients may have congenital heart defects, heart valve problems, or other structural issues that need to be corrected through surgery. In this study, the focus was on Chinese infants and small children undergoing complex heart surgery who were at risk of developing acute kidney injury (AKI) during the perioperative period.

Timeline

Before pediatric cardiac surgery, a patient may undergo various tests and evaluations to assess their heart condition and overall health. They may also meet with their surgical team to discuss the procedure and any potential risks or complications.

During pediatric cardiac surgery, the patient is put under anesthesia and the surgical team performs the necessary procedures to correct any heart defects or abnormalities. This may involve open-heart surgery, bypassing the heart, or repairing heart valves.

After pediatric cardiac surgery, the patient is closely monitored in the intensive care unit (ICU) for any complications or signs of distress. They may be on a ventilator to help with breathing and receive medications to manage pain and prevent infection.

In the days following surgery, the patient will gradually recover and begin physical therapy to regain strength and mobility. They will also have follow-up appointments with their surgical team to monitor their progress and address any concerns.

Overall, the patient’s journey before and after pediatric cardiac surgery involves thorough preparation, the surgical procedure itself, intensive care and monitoring, and ongoing rehabilitation and follow-up care to ensure a successful recovery.

What to Ask Your Doctor

  1. What is acute kidney injury (AKI) and how common is it in pediatric patients undergoing cardiac surgery?

  2. How does the NEPHROCHECK® test work and how accurate is it in predicting severe AKI in pediatric patients?

  3. What are the potential benefits of using the NEPHROCHECK® test in addition to standard post-operative monitoring in pediatric cardiac surgery patients?

  4. Are there any specific risk factors that increase the likelihood of developing AKI in pediatric patients undergoing cardiac surgery?

  5. How soon after surgery can the NEPHROCHECK® test accurately predict the development of severe AKI?

  6. What are the implications for patient outcomes if AKI is detected early using the NEPHROCHECK® test?

  7. Are there any limitations or potential drawbacks to using the NEPHROCHECK® test in pediatric patients undergoing cardiac surgery?

  8. How does the NEPHROCHECK® test compare to other methods of predicting and monitoring AKI in pediatric patients?

  9. What additional steps or interventions can be taken if the NEPHROCHECK® test indicates a high risk of developing severe AKI in a pediatric patient?

  10. Are there any ongoing research studies or future developments related to using the NEPHROCHECK® test in pediatric cardiac surgery patients?

Reference

Authors: Tao Y, Heskia F, Zhang M, Qin R, Kang B, Chen L, Wu F, Huang J, Brengel-Pesce K, Chen H, Mo X, Liang J, Wang W, Xu Z. Journal: Pediatr Nephrol. 2022 Nov;37(11):2743-2753. doi: 10.1007/s00467-022-05477-6. Epub 2022 Feb 24. PMID: 35211796