Prevention and management of acute kidney injury (acute renal failure) in children
- Prasad Devarajan, MD
Prasad Devarajan, MD
- Professor of Pediatrics and Developmental Biology
- University of Cincinnati College of Medicine
Acute kidney injury (AKI) is defined as the abrupt loss of kidney function that results in a decline in glomerular filtration rate (GFR), retention of urea and other nitrogenous waste products, and dysregulation of extracellular volume and electrolytes. The term AKI has largely replaced acute renal failure (ARF), as it more clearly defines renal dysfunction as a continuum rather than a discrete finding of failed kidney function.
Pediatric AKI presents as a wide range of clinical manifestations from a minimal elevation in serum creatinine to anuric renal failure, arises from multiple causes, and occurs in a variety of clinical settings [1-7]. The milder forms of AKI associated with dehydration are usually fully reversible with timely therapy. However, the prognosis remains guarded for critically-ill children with more severe forms of AKI in whom there is a mortality rate of 50 percent or greater .
The prevention, management, and outcomes of AKI in children are presented in this topic review. The clinical manifestations and diagnosis of AKI in children, and the approach to AKI in newborns are presented separately. (See "Acute kidney injury in children: Clinical features, etiology, evaluation, and diagnosis" and "Acute kidney injury (acute renal failure) in the newborn".)
PREVENTION OF ACUTE KIDNEY INJURY
Proven measures — General measures to prevent AKI include:
●Fluid administration in some settings, such as hypovolemia
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- PREVENTION OF ACUTE KIDNEY INJURY
- Proven measures
- - Fluid administration
- - Nephrotoxin management
- Unproven pharmacologic agents
- - Mannitol
- - Loop diuretics
- - Dopamine
- - Fenoldopam
- - Natriuretic peptides
- - N-acetylcysteine
- MANAGEMENT OF ACUTE KIDNEY INJURY
- Fluid management
- - Hypovolemia
- - Euvolemia
- - Hypervolemia
- Critically-ill children
- Electrolyte management
- - Hyperkalemia
- - Metabolic acidosis
- - Hyperphosphatemia and hypocalcemia
- Nutritional support
- Drug management
- Renal replacement therapy
- Specific pharmacologic therapies for established acute kidney injury
- PROGNOSIS AND OUTCOME OF ACUTE KIDNEY INJURY
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS