Evaluation and management of critically ill children with acute kidney injury.

PURPOSE OF REVIEW: This review will highlight recent studies on the diagnosis of acute kidney injury (AKI), review the differential diagnosis, highlight the importance of cumulative fluid overload and provide key management strategies for the pediatric patient with AKI.

RECENT FINDINGS: Over the last decade, serum creatinine-based categorical definitions of AKI have been accepted, which allow detection earlier in the disease process. Evidence-based modifications of these definitions have occurred. Fluid overload portends poor outcomes in critically ill patients. Significant improvements in our understanding of the pathophysiology of glomerular/vascular causes of AKI have occurred.

SUMMARY: Categorical definitions of AKI have shown that higher AKI portends poor outcomes even with adjustment for severity of illness and other confounders. Cumulative fluid overload independently predicts poor outcomes. Strategies to prevent and/or treat fluid overload are likely to improve outcomes.