Association of stress-induced hyperglycemia (SIH) and acute kidney injury (AKI) in critically ill children and adolescents.

Roberto Gordillo, MD

Stress-induced hyperglycemia (SIH) is common in critically ill patients and it has been associated with increased mortality and morbidity in adults and children [1-3].  However, it is still not clear whether SIH correlates with acute kidney injury (AKI) [2]. The incidence of AKI in critically ill patients is difficult to estimate because of a lack of standard definition.  Over 30 definitions of AKI have been published [4].

AKI is associated with significant mortality, as high as 60% [5].  Therefore prevention of AKI is crucial, and includes hemodynamic support, maintenance of euvolemia, and avoidance of nephrotoxic medications. Current research has identified a set of kidney injury biomarkers, i.e. neutrophil gelatinase-associated lipocalcin (NGAL), osteopontin (OPN), kidney injury molecule-1 (KIM-1), that may allow early clinical recognition of patients at risk for AKI [9].

However, those biomarkers were not evaluated during stress-hyperglycemia states.