Acute kidney injury

Abstract

Any process that interferes with the architecture and function of the renal vascular supply, the glomeruli, the renal tubule, or the urinary tract can compromise renal function. Acute kidney injury (AKI) can be defined as the sudden loss of renal function measured by a decline in GFR that develops over hours to days as a result of decreased renal perfusion, renal cell injury, or obstruction to urine outflow. The term AKI is now preferred over acute renal failure to standardize the definition and to reflect the mechanisms and entire spectrum of the disease. The etiology is usually multifactorial. Advances in pediatric critical care and surgery depend on interventions that often involve nephrotoxic exposures. The systemic inflammatory response evoked after an extensive surgical procedure or from critical illness can also lead to organ hypoperfusion, compounding the effects of nephrotoxic exposures. AKI is an independent risk factor for mortality, prolonged intubation, and increased ICU and hospital length of stay, with even higher rates of mortality in patients receiving renal replacement therapy. Early AKI detection provides the opportunity for early intervention.