An update and review of acute kidney injury in pediatrics.
OBJECTIVE
To inform the pediatric intensivist of recent advancements in acute kidney injury diagnosis and management.


METHODS
Studies were identified from MEDLINE (OVID), PubMed, and the Cochrane Library for topics relevant to acute kidney injury. We also reviewed bibliographies of relevant studies. DATA EXTRACTION, SYNTHESIS, AND OUTLINE REVIEW: Because of the lack of prospective trials, a majority of information is extracted from observational and retrospective data. The pathophysiology section reviews acute kidney injury mechanisms and highlights data regarding distal injury from experimental acute kidney injury. The epidemiology section focuses on incidence and outcomes of acute kidney injury, highlighting new strategies for diagnosis. The management section cites studies investigating hemodynamic optimization, nutrition, and fluid management, including the indications and impact of continuous renal replacement therapy in fluid overload.


CONCLUSIONS
There is limited data-driven evidence in pediatrics regarding effective therapy for acute kidney injury, a significant problem in the pediatric intensive care unit extending length of stay, ventilator days, and overall mortality. Sublethal kidney injury may be contributing to overall morbidity. We conclude that prospective clinical trials are needed to evaluate specific diagnostic aids, such as biomarkers, and therapeutic strategies, such as early initiation of continuous renal replacement therapy in children with fluid overload.
Division of Critical Care, Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, Cincinnati, OH, USA. rajit.basu@cchmc.org
Rajit K
RK
Basu
Prasad
P
Devarajan
Hector
H
Wong
Derek S
DS
Wheeler
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D017582:Renal Replacement Therapy