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Prevention and management of acute kidney injury (acute renal failure) in children

Prasad Devarajan, MD
Section Editor
Tej K Mattoo, MD, DCH, FRCP
Deputy Editor
Melanie S Kim, MD


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 with 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.

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 "Neonatal acute kidney injury: Pathogenesis, etiology, clinical presentation, and diagnosis".)


Proven measures — General measures to prevent AKI include:

Fluid administration in some settings, such as hypovolemia

Avoidance of hypotension by providing inotropic support in critically-ill children following adequate volume repletion (see "Initial management of shock in children", section on 'Early goal-directed therapy')

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Literature review current through: Nov 2017. | This topic last updated: Nov 28, 2017.
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