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Acute Kidney Injury: Diagnosis and Management

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Abstract

Pediatric medicine is growing in complexity and an increasing number of children with co-morbidities are exposed to potential renal damage. Initially ill-defined and thought to be mostly a transient phenomenon in children, acute kidney injury (AKI) has now emerged as a complex clinical syndrome independently associated with increased mortality and morbidity, including the development of chronic renal sequelae. Recent advances in molecular nephrology have better elucidated the early phase of AKI, where evidence of renal tissue damage is associated with adverse outcomes even without decrease in glomerular filtration rate, illustrating the flaws of the old paradigm based solely on an insensitive filtration marker, the serum creatinine. Prevention, prompt evaluation and early interventions are of essence to decrease AKI incidence and severity. Emerging data reveal that AKI is commonly encountered in hospitalized children, especially critically ill ones, hence the importance for all clinicians to be able to identify high risk patients, recognize AKI early and be comfortable with the initial medical management. In recent years, significant advances have been made in AKI definition and prediction, allowing early preventive measures in high risk children that are now proven to reduce AKI incidence. This review covers recent advances in the diagnosis, risk stratification, prevention and management of AKI in children.

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Authors and Affiliations

  1. Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Jean-Philippe Roy & Prasad Devarajan

  2. Department of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Prasad Devarajan

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  1. Jean-Philippe Roy
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Both authors contributed equally in the conception, planning, and execution of the submission. Both authors reviewed and approved the final submitted version. PD will act as guarantor for this paper.

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Correspondence to Prasad Devarajan.

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Conflict of Interest

Dr. Devarajan is a co-inventor on submitted patents for the use of NGAL as a biomarker for kidney injury.

Source of Funding

Work quoted in this review that was completed in the authors’ laboratory was funded by grants fromthe NIH(P50DK096418).

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Roy, JP., Devarajan, P. Acute Kidney Injury: Diagnosis and Management. Indian J Pediatr 87, 600–607 (2020). https://doi.org/10.1007/s12098-019-03096-y

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