Diagnosis and Treatment of Acute Kidney Injury in Pediatrics

Abstract

The term acute kidney injury (AKI) has replaced the outdated term acute renal failure throughout the literature and clinical practice. The term “injury” highlights the spectrum of organ injury that may occur and reflects the fact that even small changes in serum creatinine (rise of 0.3 mg/dL) can be associated with adverse outcomes. A major advance in the field of AKI research has been the development of standardized staged definitions of AKI that allow for comparison of incidence, prevalence, and outcomes across studies. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition represents the most recent consensus definition which is currently recommended for use in pediatric populations. Utilization of standard AKI definitions has made it clear that AKI occurs often in hospitalized patients and is associated with adverse short-term and long-term outcomes (hospital length of stay, mortality, subsequent chronic kidney disease). Awareness of the impact of AKI has resulted in increased efforts to understand, diagnose, prevent, and manage AKI earlier in the course of illness. While attempts at finding a treatment for AKI have been unsuccessful, largely due to the lack of sensitivity of the primary biomarker, serum creatinine, there have been many major advances in this field over the last 15 years. The development of novel biomarkers to predict the development of AKI in a timely manner and improve diagnostic accuracy is being pioneered by pediatric AKI researchers. The development of risk stratification scores (renal angina) and functional bedside tests (furosemide stress test) is enhancing our use of these biomarkers and our ability to predict those patients most likely to develop severe AKI. The recognition of the impact of fluid overload on mortality and hospital length of stay in patients with severe AKI has prompted more timely and frequent use of renal replacement therapy in critically ill children. Finally, we are recognizing that children who suffer AKI are at long-term risk for the development of chronic kidney disease and warrant follow-up.