Acute kidney injury and continuous renal replacement therapy in children; what pediatricians need to know

Abstract

Acute kidney injury (AKI) is characterized by abrupt deterioration of renal function, and its diagnosis relies on creatinine measurements and urine output. AKI is associated with higher morbidity and mortality, and is a risk factor for development of chronic kidney disease. There is no proven medication for AKI. Therefore, prevention and early detection are important. Physicians should be aware of the risk factors for AKI and should monitor renal function in high-risk patients. Management of AKI includes optimization of volume status and renal perfusion, avoidance of nephrotoxic agents, and sufficient nutritional support. Continuous renal replacement therapy is widely available for critically ill children, and this review provides basic information regarding this therapy. Long-term follow-up of patients with AKI for renal function, blood pressure, and proteinuria is recommended.

Keywords: Acute kidney injury; Child; Renal replacement therapy.

Fig. 1.

Kaplan-Meier graph for hospital survival, stratified by Kidney Disease: Improving Global Outcomes stages of acute kidney injury. Reprinted from Rewa and Bagshaw. Nat Rev Nephrol 2014;10:193-207, with permission of Springer Nature[1].

Fig. 2.

Clinical course in a patient with acute kidney injury caused by Yersinia pseudo-tuberculosis infection[14]. WBC, white blood cell; ESR, erythrocyte sedimentation rate.

Fig. 3.

Time to end-stage renal disease in patients undergoing cardiac surgery classified according to severity of acute kidney injury[52]. AKIN, acute kidney injury network.