Skip to main content
SpringerLink
Log in

Pediatric Acute Kidney Injury: Diagnosis, Epidemiology, and Treatment

  • Chapter
  • First Online:
Core Concepts in Acute Kidney Injury

  • 1573 Accesses

Abstract

Over the last decade, there has been considerable effort to standardize the definition of acute kidney injury (AKI) in pediatric patients. This has led to a clearer understanding of the incidence of childhood AKI as well as which populations appear to be at highest risk for disease development. It is now well established that AKI is a common occurrence in hospitalized children, particularly those who are critically ill. In addition, there is emerging evidence that AKI is associated with poorer short-term and long-term outcomes. Currently, there are no directed therapies that hasten renal recovery in affected patients. Treatment is largely supportive with severe cases requiring initiation of renal replacement therapy.

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 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover 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

References

  1. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute Dialysis Quality Initiative w. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204–12. https://doi.org/10.1186/cc2872.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71(10):1028–35. https://doi.org/10.1038/sj.ki.5002231.

    Article  CAS  PubMed  Google Scholar 

  3. Bresolin N, Bianchini AP, Haas CA. Pediatric acute kidney injury assessed by pRIFLE as a prognostic factor in the intensive care unit. Pediatr Nephrol. 2013;28(3):485–92. https://doi.org/10.1007/s00467–012–2357–8.

    Article  PubMed  Google Scholar 

  4. Schneider J, Khemani R, Grushkin C, Bart R. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med. 2010;38(3):933–9. https://doi.org/10.1097/CCM.0b013e3181cd12e1.

    Article  CAS  PubMed  Google Scholar 

  5. dos Santos El Halal MG, Carvalho PR. Acute kidney injury according to pediatric RIFLE criteria is associated with negative outcomes after heart surgery in children. Pediatr Nephrol. 2013;28(8):1307–14. https://doi.org/10.1007/s00467–013–2495–7.

    Article  PubMed  Google Scholar 

  6. Ricci Z, Di Nardo M, Iacoella C, Netto R, Picca S, Cogo P. Pediatric RIFLE for acute kidney injury diagnosis and prognosis for children undergoing cardiac surgery: a single-center prospective observational study. Pediatr Cardiol. 2013;34(6):1404–8. https://doi.org/10.1007/s00246–013–0662-z.

    Article  PubMed  Google Scholar 

  7. Bagga A, Bakkaloglu A, Devarajan P, Mehta RL, Kellum JA, Shah SV, et al. Improving outcomes from acute kidney injury: report of an initiative. Pediatr Nephrol. 2007;22(10):1655–8. https://doi.org/10.1007/s00467–007–0565–4.

    Article  PubMed  Google Scholar 

  8. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31. https://doi.org/10.1186/cc5713.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ozcakar ZB, Yalcinkaya F, Altas B, Ergun H, Kendirli T, Ates C, et al. Application of the new classification criteria of the Acute Kidney Injury Network: a pilot study in a pediatric population. Pediatr Nephrol. 2009;24(7):1379–84. https://doi.org/10.1007/s00467–009–1158–1.

    Article  PubMed  Google Scholar 

  10. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179–84. https://doi.org/10.1159/000339789.

    Article  PubMed  Google Scholar 

  11. Moran SM, Myers BD. Course of acute renal failure studied by a model of creatinine kinetics. Kidney Int. 1985;27(6):928–37.

    Article  CAS  PubMed  Google Scholar 

  12. Waikar SS, Bonventre JV. Creatinine kinetics and the definition of acute kidney injury. J Am Soc Nephrol. 2009;20(3):672–9. https://doi.org/10.1681/ASN.2008070669.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Carobene A, Ceriotti F, Infusino I, Frusciante E, Panteghini M. Evaluation of the impact of standardization process on the quality of serum creatinine determination in Italian laboratories. Clin Chim Acta. 2014;427:100–6. https://doi.org/10.1016/j.cca.2013.10.001.

    Article  CAS  PubMed  Google Scholar 

  14. Komenda P, Beaulieu M, Seccombe D, Levin A. Regional implementation of creatinine measurement standardization. J Am Soc Nephrol. 2008;19(1):164–9. https://doi.org/10.1681/ASN.2007020156.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet. 2005;365(9466):1231–8. https://doi.org/10.1016/S0140–6736(05)74811-X.

    Article  CAS  PubMed  Google Scholar 

  16. Parikh CR, Mishra J, Thiessen-Philbrook H, Dursun B, Ma Q, Kelly C, et al. Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney Int. 2006;70(1):199–203. https://doi.org/10.1038/sj.ki.5001527.

    Article  CAS  PubMed  Google Scholar 

  17. Han WK, Waikar SS, Johnson A, Betensky RA, Dent CL, Devarajan P, et al. Urinary biomarkers in the early diagnosis of acute kidney injury. Kidney Int. 2008;73(7):863–9. https://doi.org/10.1038/sj.ki.5002715.

    Article  CAS  PubMed  Google Scholar 

  18. Portilla D, Dent C, Sugaya T, Nagothu KK, Kundi I, Moore P, et al. Liver fatty acid-binding protein as a biomarker of acute kidney injury after cardiac surgery. Kidney Int. 2008;73(4):465–72. https://doi.org/10.1038/sj.ki.5002721.

    Article  CAS  PubMed  Google Scholar 

  19. Andreoli SP. Acute renal failure. Curr Opin Pediatr. 2002;14(2):183–8.

    Article  PubMed  Google Scholar 

  20. Flynn JT. Choice of dialysis modality for management of pediatric acute renal failure. Pediatr Nephrol. 2002;17(1):61–9. https://doi.org/10.1007/s004670200011.

    Article  CAS  PubMed  Google Scholar 

  21. Williams DM, Sreedhar SS, Mickell JJ, Chan JC. Acute kidney failure: a pediatric experience over 20 years. Arch Pediatr Adolesc Med. 2002;156(9):893–900.

    Article  PubMed  Google Scholar 

  22. Ball EF, Kara T. Epidemiology and outcome of acute kidney injury in New Zealand children. J Paediatr Child Health. 2008;44(11):642–6. https://doi.org/10.1111/j.1440–1754.2008.01373.x.

    Article  PubMed  Google Scholar 

  23. 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(1):96–101.

    Article  PubMed  Google Scholar 

  24. Sutherland SM, Ji J, Sheikhi FH, Widen E, Tian L, Alexander SR, et al. AKI in hospitalized children: epidemiology and clinical associations in a national cohort. Clin J Am Soc Nephrol. 2013;8(10):1661–9. https://doi.org/10.2215/CJN.00270113.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Palmieri T, Lavrentieva A, Greenhalgh D. An assessment of acute kidney injury with modified RIFLE criteria in pediatric patients with severe burns. Intensive Care Med. 2009;35(12):2125–9. https://doi.org/10.1007/s00134–009–1638–6.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Selewski DT, Cornell TT, Heung M, Troost JP, Ehrmann BJ, Lombel RM, et al. Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population. Intensive Care Med. 2014;40(10):1481–8. https://doi.org/10.1007/s00134–014–3391–8.

    Article  PubMed  Google Scholar 

  27. Slater MB, Anand V, Uleryk EM, Parshuram CS. A systematic review of RIFLE criteria in children, and its application and association with measures of mortality and morbidity. Kidney Int. 2012;81(8):791–8. https://doi.org/10.1038/ki.2011.466.

    Article  PubMed  Google Scholar 

  28. Plotz FB, Bouma AB, van Wijk JA, Kneyber MC, Bokenkamp A. Pediatric acute kidney injury in the ICU: an independent evaluation of pRIFLE criteria. Intensive Care Med. 2008;34(9):1713–7. https://doi.org/10.1007/s00134–008–1176–7.

    Article  PubMed  Google Scholar 

  29. Zappitelli M, Moffett BS, Hyder A, Goldstein SL. Acute kidney injury in non-critically ill children treated with aminoglycoside antibiotics in a tertiary healthcare centre: a retrospective cohort study. Nephrol Dial Transplant. 2011;26(1):144–50. https://doi.org/10.1093/ndt/gfq375.

    Article  PubMed  Google Scholar 

  30. Lex DJ, Toth R, Cserep Z, Alexander SI, Breuer T, Sapi E, et al. A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients. Ann Thorac Surg. 2014;97(1):202–10. https://doi.org/10.1016/j.athoracsur.2013.09.014.

    Article  PubMed  Google Scholar 

  31. Moffett BS, Goldstein SL. Acute kidney injury and increasing nephrotoxic-medication exposure in noncritically-ill children. Clin J Am Soc Nephrol. 2011;6(4):856–63. https://doi.org/10.2215/CJN.08110910.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kavaz A, Ozcakar ZB, Kendirli T, Ozturk BB, Ekim M, Yalcinkaya F. Acute kidney injury in a paediatric intensive care unit: comparison of the pRIFLE and AKIN criteria. Acta Paediatr. 2012;101(3):e126–9. https://doi.org/10.1111/j.1651–2227.2011.02526.x.

    Article  PubMed  Google Scholar 

  33. Sutherland SM, Byrnes JJ, Kothari M, Longhurst CA, Dutta S, Garcia P, et al. AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol. 2015;10(4):554–61. https://doi.org/10.2215/CJN.01900214.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Zappitelli M, Parikh CR, Akcan-Arikan A, Washburn KK, Moffett BS, Goldstein SL. Ascertainment and epidemiology of acute kidney injury varies with definition interpretation. Clin J Am Soc Nephrol. 2008;3(4):948–54. https://doi.org/10.2215/CJN.05431207.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 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(1):11–20. https://doi.org/10.1056/NEJMoa1611391.

    Article  PubMed  Google Scholar 

  36. Schaffzin JK, Dodd CN, Nguyen H, Schondelmeyer A, Campanella S, Goldstein SL. Administrative data misclassifies and fails to identify nephrotoxin-associated acute kidney injury in hospitalized children. Hosp Pediatr. 2014;4(3):159–66. https://doi.org/10.1542/hpeds.2013–0116.

    Article  PubMed  Google Scholar 

  37. Hinchliffe SA, Sargent PH, Howard CV, Chan YF, van Velzen D. Human intrauterine renal growth expressed in absolute number of glomeruli assessed by the disector method and Cavalieri principle. Lab Investig. 1991;64(6):777–84.

    CAS  PubMed  Google Scholar 

  38. Vieux R, Hascoet JM, Merdariu D, Fresson J, Guillemin F. Glomerular filtration rate reference values in very preterm infants. Pediatrics. 2010;125(5):e1186–92. https://doi.org/10.1542/peds.2009–1426.

    Article  PubMed  Google Scholar 

  39. Carmody JB, Swanson JR, Rhone ET, Charlton JR. Recognition and reporting of AKI in very low birth weight infants. Clin J Am Soc Nephrol. 2014;9(12):2036–43. https://doi.org/10.2215/CJN.05190514.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Viswanathan S, Manyam B, Azhibekov T, Mhanna MJ. Risk factors associated with acute kidney injury in extremely low birth weight (ELBW) infants. Pediatr Nephrol. 2012;27(2):303–11. https://doi.org/10.1007/s00467–011–1977–8.

    Article  PubMed  Google Scholar 

  41. Kaur S, Jain S, Saha A, Chawla D, Parmar VR, Basu S, et al. Evaluation of glomerular and tubular renal function in neonates with birth asphyxia. Ann Trop Paediatr. 2011;31(2):129–34. https://doi.org/10.1179/146532811X12925735813922.

    Article  CAS  PubMed  Google Scholar 

  42. Selewski DT, Jordan BK, Askenazi DJ, Dechert RE, Sarkar S. Acute kidney injury in asphyxiated newborns treated with therapeutic hypothermia. J Pediatr. 2013;162(4):725–9 e1. https://doi.org/10.1016/j.jpeds.2012.10.002.

    Article  PubMed  Google Scholar 

  43. Zwiers AJ, de Wildt SN, Hop WC, Dorresteijn EM, Gischler SJ, Tibboel D, et al. Acute kidney injury is a frequent complication in critically ill neonates receiving extracorporeal membrane oxygenation: a 14-year cohort study. Crit Care. 2013;17(4):R151. https://doi.org/10.1186/cc12830.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Alabbas A, Campbell A, Skippen P, Human D, Matsell D, Mammen C. Epidemiology of cardiac surgery-associated acute kidney injury in neonates: a retrospective study. Pediatr Nephrol. 2013;28(7):1127–34. https://doi.org/10.1007/s00467–013–2454–3.

    Article  PubMed  Google Scholar 

  45. Blinder JJ, Goldstein SL, Lee VV, Baycroft A, Fraser CD, Nelson D, et al. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg. 2012;143(2):368–74. https://doi.org/10.1016/j.jtcvs.2011.06.021.

    Article  PubMed  Google Scholar 

  46. Askenazi DJ, Koralkar R, Hundley HE, Montesanti A, Patil N, Ambalavanan N. Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate. Pediatr Nephrol. 2013;28(4):661–6. https://doi.org/10.1007/s00467–012–2369–4.

    Article  PubMed  Google Scholar 

  47. Cataldi L, Leone R, Moretti U, De Mitri B, Fanos V, Ruggeri L, et al. Potential risk factors for the development of acute renal failure in preterm newborn infants: a case-control study. Arch Dis Child Fetal Neonatal Ed. 2005;90(6):F514–9. https://doi.org/10.1136/adc.2004.060434.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Cuzzolin L, Fanos V, Pinna B, di Marzio M, Perin M, Tramontozzi P, et al. Postnatal renal function in preterm newborns: a role of diseases, drugs and therapeutic interventions. Pediatr Nephrol. 2006;21(7):931–8. https://doi.org/10.1007/s00467–006–0118–2.

    Article  PubMed  Google Scholar 

  49. Koralkar R, Ambalavanan N, Levitan EB, McGwin G, Goldstein S, Askenazi D. Acute kidney injury reduces survival in very low birth weight infants. Pediatr Res. 2011;69(4):354–8. https://doi.org/10.1203/PDR.0b013e31820b95ca.

    Article  PubMed  Google Scholar 

  50. Mathur NB, Agarwal HS, Maria A. Acute renal failure in neonatal sepsis. Indian J Pediatr. 2006;73(6):499–502.

    Article  CAS  PubMed  Google Scholar 

  51. Askenazi DJ, Griffin R, McGwin G, Carlo W, Ambalavanan N. Acute kidney injury is independently associated with mortality in very low birthweight infants: a matched case-control analysis. Pediatr Nephrol. 2009;24(5):991–7. https://doi.org/10.1007/s00467–009–1133-x.

    Article  PubMed  Google Scholar 

  52. Sarkar S, Askenazi DJ, Jordan BK, Bhagat I, Bapuraj JR, Dechert RE, et al. Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia. Pediatr Res. 2014;75(3):431–5. https://doi.org/10.1038/pr.2013.230.

    Article  PubMed  Google Scholar 

  53. Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Curr Opin Pediatr. 2012;24(2):191–6. https://doi.org/10.1097/MOP.0b013e32834f62d5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Foland JA, Fortenberry JD, Warshaw BL, Pettignano R, Merritt RK, Heard ML, et al. Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med. 2004;32(8):1771–6.

    Article  PubMed  Google Scholar 

  55. Selewski DT, Cornell TT, Blatt NB, Han YY, Mottes T, Kommareddi M, et al. Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy. Crit Care Med. 2012;40(9):2694–9. https://doi.org/10.1097/CCM.0b013e318258ff01.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Selewski DT, Cornell TT, Lombel RM, Blatt NB, Han YY, Mottes T, et al. Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med. 2011;37(7):1166–73. https://doi.org/10.1007/s00134–011–2231–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Sutherland SM, Zappitelli M, Alexander SR, Chua AN, Brophy PD, Bunchman TE, 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(2):316–25. https://doi.org/10.1053/j.ajkd.2009.10.048.

    Article  PubMed  Google Scholar 

  58. Modem V, Thompson M, Gollhofer D, Dhar AV, Quigley R. Timing of continuous renal replacement therapy and mortality in critically ill children*. Crit Care Med. 2014;42(4):943–53. https://doi.org/10.1097/CCM.0000000000000039.

    Article  CAS  PubMed  Google Scholar 

  59. Mammen C, Al Abbas A, Skippen P, Nadel H, Levine D, Collet JP, et al. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis. 2012;59(4):523–30. https://doi.org/10.1053/j.ajkd.2011.10.048.

    Article  PubMed  Google Scholar 

  60. Askenazi DJ, Feig DI, Graham NM, Hui-Stickle S, Goldstein SL. 3–5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int. 2006;69(1):184–9. https://doi.org/10.1038/sj.ki.5000032.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Nephrology, University of Vermont Medical Center, Larner College of Medicine at UVM, Burlington, VT, USA

    Elizabeth A. K. Hunt

  2. Division of Nephrology, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Michael A. Ferguson

Authors
  1. Elizabeth A. K. Hunt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael A. Ferguson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael A. Ferguson .

Editor information

Editors and Affiliations

  1. Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Sushrut S. Waikar

  2. University College Dublin, Dublin, Ireland

    Patrick T. Murray

  3. Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Ajay K. Singh

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Science+Business Media, LLC, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hunt, E.A.K., Ferguson, M.A. (2018). Pediatric Acute Kidney Injury: Diagnosis, Epidemiology, and Treatment. In: Waikar, S., Murray, P., Singh, A. (eds) Core Concepts in Acute Kidney Injury. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-8628-6_15

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-8628-6_15

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-8626-2

  • Online ISBN: 978-1-4939-8628-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation