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Pediatric Critical Care pp 177–191Cite as

Diagnosis and Management of Acute Kidney Injury in Critical Illness

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Abstract

This is an exciting time in the world of acute kidney injury (AKI) research as there are new developments in methods to provide earlier diagnosis, streamline management, and offer additional therapeutic options via renal replacement therapy that would have otherwise not been a possibility a few years ago. However, questions still remain of our ability to appropriately diagnose and manage patients at risk for AKI. Is current therapy good enough? Are we moving in the right direction? The purpose of this chapter is to not focus on the physiology of AKI but to discuss advancements in early detection and management while at the same time recognizing that there is still much to be done.

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Summary

AKI remains extremely common and impacts outcomes for critically ill pediatric patients. AKI is no longer thought to be a transient event, but there is evidence of long-term sequelae including hypertension, proteinuria, CKD, and ESRD that should be monitored via long-term care. The standardization of an AKI definition via KDIGO has improved the ability to better evaluate AKI in the pediatric population including better understanding of the epidemiology. Urine output should be a part of AKI surveillance programs. The ongoing investigation of novel biomarkers and their proper incorporation into clinical decision making has made promising strides in AKI research with anticipation of providing earlier diagnosis, thus leading to timely therapy and better long-term outcomes. Fluid overload is common in AKI and is associated with poor outcomes, therefore ongoing evaluation and management of fluid balance is very important. Care must be taken to not become overly aggressive with fluid resuscitation in order to prevent the need for emergent fluid removal later on. New technology has made significant advancements and promises to improve the safety of RRT in neonates or small infants who would have otherwise not been eligible for these therapies.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Nephrology, University of Alabama at Birmingham School of Medicine, Children’s of Alabama, Birmingham, AL, USA

    Tennille N. Webb & David Askenazi

  2. Department of Pediatrics, Division of Pediatric Critical Care Medicine, Emory School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Rajit Basu

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  1. Tennille N. Webb
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Correspondence to Tennille N. Webb .

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Editors and Affiliations

  1. Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA

    Christopher W. Mastropietro

  2. Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA

    Kevin M. Valentine

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Webb, T.N., Basu, R., Askenazi, D. (2019). Diagnosis and Management of Acute Kidney Injury in Critical Illness. In: Mastropietro, C., Valentine, K. (eds) Pediatric Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-96499-7_10

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