Zinter MS, et al. - In this prospective observational study, researchers investigated risk factors for the development of acute kidney injury and elevated cumulative fluid balance in pediatric acute respiratory distress syndrome, as well as assessed their independent associations with mortality. They also investigated whether acute kidney injury and elevated cumulative fluid balance would be related to markers of inflammation, and whether worse outcomes would be seen in children with elevated cumulative fluid balance and concomitant acute kidney injury vs other children. They found a link between elevated cumulative fluid balance on day 3 of acute respiratory distress syndrome and mortality, especially in patients with concomitant acute kidney injury. Findings revealed an association of plasma interleukin-6 levels with the development of positive cumulative fluid balance and acute kidney injury, indicating a potential mechanism by which inflammation might predispose to mortality.