Acute Kidney Injury: Principles of Management

  • Jitendra Meena
  • Arvind Bagga


Acute kidney injury (AKI) is characterized by rapid decline in renal function with accumulation of nitrogenous waste and inability of kidney to maintain fluid and electrolyte homeostasis. The term acute renal failure had been replaced by AKI since it represents renal dysfunction as a continuum rather than a discrete finding of failed function. The manifestations of AKI are wide, ranging from minimal elevation of serum creatinine to anuric renal failure. AKI can occur in variety of clinical settings and is associated with several short- and long-term morbidities and increased mortality.


  1. 1.
    Lameire NH, Bagga A, Cruz D, De Maeseneer J, Endre Z, Kellum JA, et al. Acute kidney injury: an increasing global concern. Lancet. 2013;382:170–9.CrossRefGoogle Scholar
  2. 2.
    Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative Workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204–12.CrossRefGoogle Scholar
  3. 3.
    Akcan-Arikan A, Zappitelli M, Loftis LL, Wasburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71:1028–35.CrossRefGoogle Scholar
  4. 4.
    Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.CrossRefGoogle Scholar
  5. 5.
    Kellum JA, et al. Kidney disease: improving global outcome (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:124–38.CrossRefGoogle Scholar
  6. 6.
    Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL, AWARE Investigators. Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med. 2017;376(1):11–20.CrossRefGoogle Scholar
  7. 7.
    Jetton JG, Boohaker LJ, Sethi SK, Wazir S, Rohatgi S, Soranno DE, et al. Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health. 2017;1(3):184–94.CrossRefGoogle Scholar
  8. 8.
    Cerdá J, Bagga A, Kher V, Chakravarthi RM. The contrasting characteristics of acute kidney injury in developed and developing countries. Nat Clin Pract Nephrol. 2008;4(3):138–53.CrossRefGoogle Scholar
  9. 9.
    Feehally J. The ISN 0by25 global snapshot study. Ann Nutr Metab. 2016;68(Suppl 2):29–31.CrossRefGoogle Scholar
  10. 10.
    Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Curr Opin Pediatr. 2012;24(2):191–6.CrossRefGoogle Scholar
  11. 11.
    Mian AN, Askenazi DJ, Mhanna MJ. Therapeutic options for neonatal acute kidney injury (AKI). Curr Treat Options Pediatr. 2016;2(2):69–81.CrossRefGoogle Scholar
  12. 12.
    Goldstein SL, Chawla LS. Renal angina. Clin J Am Soc Nephrol. 2010;5(5):943–9.CrossRefGoogle Scholar
  13. 13.
    Ciccia E, Devarajan P. Pediatric acute kidney injury: prevalence, impact and management challenges. Int J Nephrol Renovasc Dis. 2017;10:77–84.CrossRefGoogle Scholar
  14. 14.
    Walters G. Role of therapeutic plasmapheresis in ANCA-associated vasculitis. Pediatr Nephrol. 2016;31:217.CrossRefGoogle Scholar
  15. 15.
    Friedrich JO, Adhikari N, Herridge MS, Beyene J. Metaanalysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. Ann Intern Med. 2005;142:510–24.CrossRefGoogle Scholar
  16. 16.
    Li Y, Tang X, Zhang J, Wu T. Nutritional support for acute kidney injury. Cochrane Database Sys Rev. 2012;8:CD005426.Google Scholar
  17. 17.
    Sethi SK, Maxvold N, Bunchman T, Jha P, Kher V, Raina R. Nutritional management in the critically ill child with acute kidney injury: a review. Pediatr Nephrol. 2017;32(4):589–601.CrossRefGoogle Scholar
  18. 18.
    Walters S, Porter C, Brophy PD. Dialysis and pediatric acute kidney injury: choice of renal support modality. Pediatr Nephrol. 2009;24:37–48.CrossRefGoogle Scholar
  19. 19.
    Sutherland SM, Zappitelli M, Alexander SR, Chua AN, Brophy PD, Bunchman TE, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis. 2010;55:316–25.CrossRefGoogle Scholar
  20. 20.
    Macedo E, Cerdá J, Hingorani S, Hou J, Bagga A, Burdmann EA, et al. Recognition and management of acute kidney injury in children: The ISN 0by25 Global Snapshot study. PLoS One. 2018;13(5):e0196586.CrossRefGoogle Scholar
  21. 21.
    Greenberg JH, Coca S, Parikh CR. Long-term risk of chronic kidney disease and mortality in children after acute kidney injury: a systematic review. BMC Nephrol. 2014;15:184.CrossRefGoogle Scholar
  22. 22.
    Sigurjonsdottir VK, Chaturvedi S, Mammen C, Sutherland SM. Pediatric acute kidney injury and the subsequent risk for chronic kidney disease: is there cause for alarm? Pediatr Nephrol. 2018;33(11):2047–55.CrossRefGoogle Scholar
  23. 23.
    Mehta R, Bagga A, Patibandla R, Chakravarthi R. Detection and management of AKI in the Developing World: The 18th Acute Disease Quality Initiative (ADQI) International Consensus Conference. Kidney Int Rep. 2017;2(4):515–51.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Jitendra Meena
    • 1
  • Arvind Bagga
    • 1
  1. 1.Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in NephrologyAll India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations