Evaluation and Management of Acute Kidney Injury in Children

Abstract

Acute kidney injury (AKI) occurs in 5% of hospitalized children and 20-30% of children admitted to the intensive care unit (ICU). AKI is associated with poor patient outcomes, including increased risk of mortality, prolonged length of ICU and hospital stay, and prolonged invasive mechanical ventilation. Children with severe AKI and those requiring kidney replacement therapy (KRT), particularly infants and those with multiple organ dysfunction, experience mortality rates up to 70%. AKI has now been acknowledged as a common and frequently overlooked multidimensional syndrome, with additional longlasting negative impacts on kidney health, even when function has apparently recovered after the inciting episode. The present chapter will extensively discuss how to identify and accurately diagnose an AKI episode in a timely fashion, novel research tools that are currently available to anticipate an AKI episode, risk factors that the clinician should be aware of to prevent kidney injury, and available pharmacological strategies, including management of fluid balance. An extensive section detailing technical and relevant aspects of acute pediatric dialysis is provided at the end of the chapter. Current initiatives to guide the care of patients with AKI and focus on increasing awareness (by patients, healthcare providers, and healthcare systems) as well as on research to improve AKI diagnosis and healthcare delivery, with a goal of improving the currently poor outcomes in this particularly at-risk population, are discussed.