Each nephron is worth every heartbeat: navigating acute kidney injury in children post-cardiac surgery

Abstract Cardiac Surgery-associated acute kidney injury (CS-AKI) is a common complication in children. Comparison of studies over the last 2 decades has been difficult because of varying definitions and practice heterogeneity. Multiple risk factors exist; however, few are modifiable. Limitations in serum creatinine and urine output have hampered precision in CS-AKI diagnosis. Delineating CS-AKI using durational, biomarker-based, and fluid sub-phenotypes has strengthened associations with outcomes. Despite the significant short and long-term effects of CS-AKI, no study has proven efficacious for its prevention or treatment. Targeted early risk stratification tools should be considered for prognostication and possible clinical trial enrichment. Long-term consequences of CS-AKI need further study, given the inconsistency in findings, through systematic follow-up of these high-risk patients.