Management of Severe Acute Kidney Injury

Abstract

Acute kidney injury (AKI) is encountered in approximately one-fourth of children admitted to the intensive care units (ICUs). As AKI is known to prolong ICU stay as well as increase the overall morbidity and mortality, it is important to identify it timely and take appropriate measures to curtail further injury. Infections continue to be the most common cause in developing countries. While pneumonia, diarrhea, and tropical infections such as dengue, malaria, scrub typhus, and leptospirosis are major causes of AKI in children; glomerular diseases, systemic disorders, envenomations, and drugs also account for a major proportion of AKI in low and low-middle income countries. Fluid overload is associated with adverse outcomes in multiple studies; hence proper assessment of volume status is vital. Novel prognostic markers such as renal angina index and furosemide stress test are increasingly being applied in routine clinical care. The current guidelines recommend against the usage of furosemide for the prevention and management of AKI, except in a situation of fluid overload. Kidney replacement therapy (KRT) should be initiated promptly in AKI when indicated. The timing of initiation of KRT in AKI continues to be debatable and has attracted considerable research. While peritoneal dialysis continues to be the modality most often used in infants and young children, continuous KRT and sustained low-efficiency dialysis are used in hemodynamically unstable patients. Timely identification and management of the various complications reduce mortality. Cutting-edge multinational trials over the past decade have significantly impacted our understanding in managing this complex disorder.