Acute Kidney Injury in Pediatric Sepsis

Acute kidney injury is a common morbidity of pediatric sepsis and carries an increased risk of mortality. The pathophysiology of sepsis associated acute kidney injury was previously believed to be secondary to decreased global renal perfusion causing hypoxia-induced injury; however, newer research suggests this paradigm is overly simplistic, and injury is now considered multifactorial in origin. Mechanisms that contribute to kidney injury include alterations in microvascular renal blood flow, inflammation and changes in bioenergetics. Clinically, defining acute kidney injury has undergone recent examination and revision, with new interest in evaluating novel biomarkers which measure kidney function more accurately with greater predictive power for patient outcomes. Specific interventions to prevent sepsis associated kidney injury by emergency care practitioners and other frontline providers are currently lacking, and no significant evidence for such practices exist. With a growing understanding of the mechanisms of injury, novel therapeutic targets have been proposed, but current human studies have yet to be performed to help guide the practitioner.