Introduction: Acute Kidney Injury and Continuous Renal Replacement Therapy

Abstract

Acute kidney injury (AKI) is characterized by a sudden reduction in renal function resulting in the accumulation of nitrogenous compounds such as urea and creatinine in the blood. AKI is classified into three categories: (1) pre-renal disease, (2) intrinsic renal disease, and (3) post-renal disorders. Ischemic injury, nephrotoxic agents, and sepsis are among the major causes of AKI. AKI occurs in approximately 5 % of hospitalized patients or more than 30 % of critically ill patients. In recent years, there have been significant advancements in our understanding of AKI and its impact on outcomes across the medicine. There has been great progress on the definition, diagnosis, risk factors, epidemiology, evaluation, outcomes, and management of AKI in children including continuous renal replacement therapies. There is a strong epidemiologic association between development of AKI and subsequent development and progression of chronic kidney disease (CKD). It is recommended to define AKI according to the RIFLE classification system into risk, injury, and failure. It is also recommended to base the decision when to start continuous renal replacement therapy (CRRT) not only on the severity of AKI but also on the severity of other organ failure. We put forth and highlight the pediatric AKI modified RIFLE definition of AKI, discuss risk factors for pediatric AKI and provide recommendations for the evaluation and treatment of these patients, and identify those children who require CRRT. Renewed knowledge into these aspects of AKI may prove helpful in initiating early therapeutic interventions that can attenuate development of CKD and improve clinical outcomes in children with AKI.