Evaluation and management of acute kidney injury in children

Abstract

The field of acute kidney injury (AKI) has undergone a dramatic change over the past decade. Intensive recent research which standardized AKI definitions and improved the clinician’s ability to identify individuals at highest risk of developing AKI reveals the strong association between AKI and negative patient outcomes. An ongoing paradigm shift is occurring with regard to identifying the presence of AKI using kidney tissue injury biomarkers before evidence of kidney dysfunction is present. The lack of current AKI-specific therapy has had the secondary benefit of developing a strong appreciation of the importance of AKI prediction, prevention, and management of its complications early in the course of critical illness. The recent formation of several national and international AKI organizations [1–4] has led to increased AKI awareness, promotion of research, and the development of the first ever AKI clinical practice guideline document [1]. This chapter will review standard clinical evaluation and differential diagnosis of AKI, while considering recent research with respect to AKI definitions, novel diagnostic tests, and prevention strategies, followed by a description of current knowledge on treatment of severe AKI, using renal replacement therapy (RRT).