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Acute Kidney Injury in Children

Sriram Krishnamurthy , Sriram Krishnamurthy

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Indian Journal of Trauma and Emergency Pediatrics 2(4):p 171-180, October - December 2010. | DOI:

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Abstract

Acute renal failure is an important cause of morbidity and mortality in children. Since it has been variously defined in the past, leading to wide variations in the reported incidence and mortality of the condition, the Acute Kidney Injury Network (AKIN), an expert body comprising of nephrologists and intensivists worldwide, has replaced the term ‘acute renal failure’ by ‘acute kidney injury (AKI)’ and adopted a uniform definition and classification for the new terminology. The new AKIN classification is useful since early detection of AKI helps in commencement of several preventive and therapeutic strategies including avoidance of potentially nephrotoxic drugs, judicious usage of radio-contrast imaging studies, appropriate fluid management, correction of acid-base and electrolyte disturbances, and optimization of blood pressure control. It also allows rational comparison of studies that assess preventive and therapeutic AKI strategies, helps in generalization of data generated from single center studies, and allows patient stratification based on AKI severity. AKI has a wide differential diagnosis. History can help classify the pathophysiology of AKI as prerenal, intrinsic renal or postrenal failure, and may suggest a specific etiology.  While sepsis, glomerulonephritis, hemolytic uremic syndrome, acute tubular necrosis and obstructive nephropathy predominate in developing countries, these have been replaced by hemato-oncologic complications and pulmonary failure as causes of AKI in the western world. This review summarizes the epidemiology, etiopathogenesis, evaluation and management of children with AKI. Current concepts regarding pharmacological interventions for early management of AKI and the long term outcome of pediatric AKI are also discussed.

Key words: Acute kidney injury; RIFLE classification; Renal replacement therapy

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