Acute kidney injury in children

Acute kidney injury (AKI) is defined as an abrupt or rapid decline in renal function.The condition often is transient and usually completely reversible. Pediatric retrospective studies have reported incidences of AKI in pediatric intensive care units (ICU) of between 8% and 30%. A new classification system, the risk injury failure loss end-stage renal disease (RIFLE) criteria (risk of renal dysfunction, injury to the kidney, failure or loss of kidney function, and end-stage kidney disease) has been introduced as standardized criteria for AKI in pediatric patients.The causes of AKI can be categorized as pre-renal, renal, or post-renal failure. A careful history and physical examination can frequently identify the likely processes that underlie AKI and suggest an underlying diagnosis. Urinalysis is the most important non-invasive test in the diagnostic evaluation. Renal ultrasonography should be performed in all children with AKI of unclear etiology. Biomarkers of the detection of AKI can also help differentiate between pre-renal, intrinsic renal or post-renal AKI and aid in identifying the etiology of AKI. They could also differentiate AKI from other forms of kidney disease such as urinary tract infection, interstitial nephritis, and glomerulonephritis. Besides the specific therapy for the underlying cause of AKI, specific attention should be focused on frequent assessment of fluid status and avoidance of any nephrotoxic insults. Children with AKI from any cause have a significant risk of kidney disease in later life, and should be on long-term follow-up so that interventions can be initiated at appropriate time.