Skip to main content
SpringerLink
Log in

Acute Kidney Injury

  • Chapter
  • First Online:
Pediatric Critical Care

  • 2849 Accesses

Abstract

Acute renal failure, now termed acute kidney injury (AKI), is a common occurrence in the pediatric intensive care unit. It impacts the management decisions and outcomes of critically ill patients. This chapter will review the factors involved in measuring renal function in children and recognizing abnormal renal function. The major clinical subtypes of AKI and how to distinguish between them will be addressed as well as some of the more common causes within each subtype. Management of AKI will be reviewed, including the indications for renal replacement therapy. The impact of impairment of renal function on the overall management and outcome of the critically ill pediatric patient will be discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Suggested Reading

  • Askenazi DJ, Ambalavanan N, Goldstein SL. Acute kidney injury in critically ill newborns: what do we know? What do we need to learn? Pediatr Nephrol. 2009;24:265–74.

    PubMed  PubMed Central  Google Scholar 

  • Barletta GM, Bunchman TE. Acute renal failure in children and infants. Curr Opin Crit Care. 2004;10:499–504.

    PubMed  Google Scholar 

  • Bhat MA, Shah ZA, Makhdoomi MS, Mufti MH. Theophylline for renal function in term neonates with perinatal asphyxia: a randomized, placebo-controlled trial. J Pediatr. 2006;149:180–4.

    CAS  PubMed  Google Scholar 

  • Bunchman TE, McBryde KD, Mottes TE, et al. Pediatric acute renal failure: outcome by modality and disease. Pediatr Nephrol. 2001;16:1067–71.

    CAS  PubMed  Google Scholar 

  • Cantarovich MD, Rangoonwala B, Lorenz H, et al. High-dose furosemide for established ARF: a prospective, randomized, double-blind, placebo-controlled, multicenter trial. Am J Kidney Dis. 2004;44:402–9.

    CAS  PubMed  Google Scholar 

  • Carvounis CP, Nisar S, Guro-Razuman S. Significance of the fractional excretion of urea in the differential diagnosis of acute renal failure. Kidney Int. 2002;62:2223–9.

    CAS  PubMed  Google Scholar 

  • Cook KM, Gillon J, Grisso AG, et al. Incidence of nephrotoxicity among pediatric patients receiving vancomycin with either piperacillin–tazobactam or cefepime: a cohort study. J Pediatric Infect Dis Soc. 2019;8:221–7.

    PubMed  Google Scholar 

  • Devarajan P. The future of pediatric acute kidney injury management–biomarkers. Semin Nephrol. 2008;28:493–8.

    PubMed  PubMed Central  Google Scholar 

  • Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis. 2002;40:221–6.

    CAS  PubMed  Google Scholar 

  • Diskin CJ, Stokes TJ, Dansby LM, Radcliff L, Carter TB. The comparative benefits of the fractional excretion of urea and sodium in various azotemic oliguric states. Nephron Clin Pract. 2010;114:145–50.

    Google Scholar 

  • Drukker A, Guignard JP. Renal aspects of the term and preterm infant: a selective update. Curr Opin Pediatr. 2002;14:174–82.

    Google Scholar 

  • Durmaz I, Yagdi T, Calkavur T, et al. Prophylactic dialysis in patients with renal dysfunction undergoing on-pump coronary artery bypass surgery. Ann Thorac Surg. 2003;75:859–64.

    PubMed  Google Scholar 

  • Foland JA, Fortenberry JD, Warshaw BL, et al. Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med. 2004;32:1771–6.

    PubMed  Google Scholar 

  • Galley HF. Renal-dose dopamine: will the message now get through? Lancet. 2000;356:2112–3.

    CAS  PubMed  Google Scholar 

  • Goldstein SL. Fluid management in acute kidney injury. J Intensive Care Med. 2014;29:183–9.

    PubMed  Google Scholar 

  • Goldstein SL, Currier H, Graf CD, et al. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics. 2001;107:1309–12.

    CAS  PubMed  Google Scholar 

  • Greenberg JH, Parikh CR. Biomarkers for diagnosis and prognosis of AKI in children one size does not fit all. Clin J Am Soc Nephrol. 2017;12:1551–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Han WK, Bonventre JV. Biologic markers for the early detection of acute kidney injury. Curr Opin Crit Care. 2004;10:476–82.

    PubMed  Google Scholar 

  • Honore PM, Jacobs R, De Waele E, Spapen HD. Applying pharmacokinetic/pharmacodynamics principles for optimizing antimicrobial therapy during continuous renal replacement therapy. Anaesthesiol Intensive Ther. 2017;49:412–8.

    PubMed  Google Scholar 

  • Hoorn EJ. Intravenous fluids: balancing solutions. J Nephrol. 2017;30:485–92.

    PubMed  Google Scholar 

  • Hsu CW, Symons JM. Acute kidney injury: can we improve prognosis? Pediatr Nephrol. 2010;25:2401–12.

    PubMed  Google Scholar 

  • Hui-Stickle S, Brewer ED, Goldstein SL. Pediatric ARF: epidemiology at a tertiary care center from 1999 to 2001. Am J Kidney Dis. 2005;45:96–101.

    PubMed  Google Scholar 

  • Joannidid M, Druml W, Forni LG, et al. Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017. Intensive Care Med. 2017;43:730–49.

    Google Scholar 

  • 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;376:11–20.

    PubMed  Google Scholar 

  • Kelly AM, Dwamena B, Cronin P, Bernstein SJ, Carlos RC. Meta-analysis: effectiveness of drugs for preventing contrast-induced nephropathy. Ann Intern Med. 2008;148:284–94.

    PubMed  Google Scholar 

  • KDIGO clinical practice guideline for acute kidney injury. Kidney Int. 2012;2(Suppl 1):19–22.

    Google Scholar 

  • Knight EL, Verhave JC, Spiegleman D, et al. Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int. 2004;65:1416–21.

    CAS  PubMed  Google Scholar 

  • Kuiper JW, Groenveld ABJ, Slutsky AS, et al. Mechanical ventilation and acute renal failure. Crit Care Med. 2005;33:1408–15.

    PubMed  Google Scholar 

  • Kwiatkowski DM, Menon S, Krawczeski CD, et al. Improved outcomes with peritoneal dialysis catheter placement after cardiopulmonary bypass in infants. J Thorac Cardiovasc Surg. 2015;149:230–6.

    PubMed  Google Scholar 

  • Lameire N, Vanholder R. Pathophysiologic features and prevention of human and experimental acute tubular necrosis. J Am Soc Nephrol. 2001;12:S20–32.

    PubMed  Google Scholar 

  • Lameire N, Vanholder R, van Biesen W. Loop diuretics for patients with acute renal failure: helpful or harmful? JAMA. 2002;288:2599–601.

    PubMed  Google Scholar 

  • Lee SA, Cozzi M, Bush EL, Rabb H. Distant organ dysfunction in acute kidney injury: a review. Am J Kidney Dis. 2018;72:846–56.

    PubMed  PubMed Central  Google Scholar 

  • McLaughlin GE, Abitbol CL. Reversal of oliguric tacrolimus nephrotoxicity in children. Nephrol Dial Transplant. 2005;20:1471–5.

    CAS  PubMed  Google Scholar 

  • Mehta RL, Pascual MT, Soroko S, et al. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA. 2002;288:2547–53.

    CAS  PubMed  Google Scholar 

  • Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA. 2004;291:2328–34.

    CAS  PubMed  Google Scholar 

  • Mishra J, Dent C, Tarabishi R, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet. 2005;365:1231–8.

    CAS  PubMed  Google Scholar 

  • Moffett BS, Goldstein SL. Acute kidney injury and increasing nephrotoxic-medication exposure in noncritically-ill children. Clin J Am Soc Nephrol. 2011;6:856–63.

    PubMed  PubMed Central  Google Scholar 

  • Moghal NE, Brockelbank JT, Meadow SR. A review of acute renal failure in children: incidence, etiology and outcome. Clin Nephrol. 1998;49:91–5.

    CAS  PubMed  Google Scholar 

  • Ng DL, Schwartz GJ, Schneider MF, et al. Combination of pediatric and adult formulas yield valid glomerular filtration rate estimates in young adults with a history of pediatric chronic kidney disease. Kidney Int. 2018;94:170–7.

    PubMed  PubMed Central  Google Scholar 

  • Prowle JR, Echeverri JE, Ligabo EV, et al. Fluid balance and acute kidney injury. Nat Rev Nephrol. 2010;6:107–15.

    PubMed  Google Scholar 

  • Riley AA, Watson M, Smith C, et al. Pediatric continuous renal replacement therapy: have practice changes changed outcomes? A large single-center ten-year retrospective evaluation. BMC Nephrol. 2018;19:268.

    PubMed  PubMed Central  Google Scholar 

  • Rivers E, Nguyen B, Havstad S, Early Goal-Directed Therapy Collaborative Group, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–77.

    CAS  PubMed  Google Scholar 

  • Safirstein RL. Acute renal failure: from renal physiology to the renal transcriptome. Kidney Int. 2004;66(suppl 91):S62–6.

    Google Scholar 

  • Schrier RW, Wang W. Acute renal failure and sepsis. N Engl J Med. 2004;351:159–69.

    CAS  PubMed  Google Scholar 

  • Schrier RW, Wang W, Poole B, et al. Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Invest. 2004;114:5–14.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin N Am. 1987;34:571–90.

    CAS  Google Scholar 

  • Shilliday IR, Quinn KJ, Allison ME. Loop diuretics in the management of acute renal failure: a prospective, double-blind, placebo-controlled, randomized study. Nephrol Dial Transplant. 1997;12:2592–6.

    CAS  PubMed  Google Scholar 

  • Solomon R, Grodon P, Manoukian SV, BOSS Trial Investigators, et al. Randomized trial of bicarbonate or saline study for the prevention of contrast-induced nephropathy in patients with CKD. Clin J Am Soc Nephrol. 2015;10:1519–24.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Sutherland SM, Zappitelli M, Alexander SR, 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.

    PubMed  Google Scholar 

  • Uber AM, Sutherland SM. Acute kidney injury in hospitalized children: consequences and outcomes. Pediatr Nephrol. 2020;35:213–20.

    PubMed  Google Scholar 

  • Uchino S, Doig GS, Bellomo R, et al. Diuretics and mortality in acute renal failure. Crit Care Med. 2004;32:1669–77.

    PubMed  Google Scholar 

  • van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359–67.

    PubMed  Google Scholar 

  • Veltri MA, Neu AM, Fivush BA, et al. Drug dosing during intermittent hemodialysis and continuous renal replacement therapy. Pediatr Drugs. 2004;6:45–65.

    Google Scholar 

  • Williams DM, Sreedhar SS, Mickell JJ, et al. Acute kidney failure: a pediatric experience over 20 years. Arch Pediatr Adolesc Med. 2002;156:893–900.

    PubMed  Google Scholar 

  • Williams C, Borges K, Banh T, et al. Patterns of kidney injury in pediatric nonkidney solid organ transplant recipients. Am J Transplant. 2018;18:1481–8.

    CAS  PubMed  Google Scholar 

  • Wyatt CM, Camargo M, Coca SG. Prophylactic hydration to prevent contrast-induced nephropathy: much ado about nothing? Kidney Int. 2017;92:4–6.

    PubMed  Google Scholar 

  • Zappitelli M, Krawczeski CD, Devarajan P, et al. TRIBE-AKI consortium. Early postoperative serum cystatin C predicts severe acute kidney injury following pediatric cardiac surgery. Kidney Int. 2011;80:655–62.

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Nephrology, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children’s Hospital, Rochester, NY, USA

    William S. Varade

  2. Pediatric Nephrology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Elif Erkan

Authors
  1. William S. Varade
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elif Erkan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elif Erkan .

Editor information

Editors and Affiliations

  1. Penn State Hershey Children’s Hospital, Pediatric Critical Care Medicine, Hershey, PA, USA

    Steven E. Lucking

  2. Division of Pediatric Critical Care, Department of Pediatrics, Janet Weis Children’s Hospital, Geisinger Medical Center, Danville, PA, USA

    Frank A. Maffei

  3. Department of Pediatrics/Divisions of Pediatric Critical and Palliative Care Medicine, Janet Weis Children’s Hospital at Geisinger, Geisinger Commonwealth School of Medicine, Danville, PA, USA

    Robert F. Tamburro

  4. Department of Pediatrics, Eastern Virginia Medical School, Children’s Hospital of The King’s Daughters, Norfolk, VA, USA

    Arno Zaritsky

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Varade, W.S., Erkan, E. (2021). Acute Kidney Injury. In: Lucking, S.E., Maffei, F.A., Tamburro, R.F., Zaritsky, A. (eds) Pediatric Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-030-53363-2_31

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-53363-2_31

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-53362-5

  • Online ISBN: 978-3-030-53363-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation