An Update on Neonatal and Pediatric Acute Kidney Injury

Abstract

The purpose of this review is to highlight the major advances of pediatric and neonatal acute kidney injury (AKI) research over the last 5 years with particular interest in describing renal physiology, the definition of AKI, risk factors, epidemiology, interventions, and outcomes. The utilization of standardized definitions of AKI has revolutionized our understanding of the incidence and impact of AKI. This has culminated in the seminal Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology in critically ill children (AWARE), and Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) publications in pediatric and neonatal AKI, respectively. These studies have clearly shown an independent association of AKI with mortality in critically ill children and neonates. Recent work aimed at the prevention of AKI has demonstrated that nephrotoxic medication-induced AKI occurs commonly and can be prevented with protocolized renal function monitoring. This review also highlights advances in the early identification of patients at risk for the development of AKI via scoring systems (renal angina index), functional tests (furosemide stress test), or novel biomarkers. Furthermore, fluid overload has clearly been shown to impact outcomes in those with the most severe forms of AKI requiring renal replacement therapy. Recent single-center studies have highlighted that children with AKI are at increased risk of chronic kidney disease. The incidence and adverse impact of AKI on outcomes across critically ill pediatric and neonatal populations have been clearly established The importance of fluid overload in children with severe AKI requiring renal replacement therapy is clear. Children with AKI are at increased risk of chronic kidney disease and require long-term outpatient follow-up. As the impact of AKI has become clear, efforts have shifted to prevention of nephrotoxic-induced AKI, early identification, risk stratification (renal angina), and the development of novel biomarkers.