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Treatment of acute kidney injury in children: from conservative management to renal replacement therapy

Nature Clinical Practice Nephrology volume 4, pages 510–514 (2008)Cite this article

Abstract

Over the past two decades, the etiology and therapy of acute kidney injury (AKI) in children has changed. Historically, hemolytic uremic syndrome was the major cause of pediatric AKI, but advances in technology have meant that sepsis and deterioration of often unrecognized long-term organ dysfunction are now more common causes of pediatric AKI in the developed world. At the same time, major advances in renal replacement therapy in children have occurred as a result of improved strategies for vascular access, more-adaptable equipment, and better techniques and protocols. This Review outlines the etiology, incidence, diagnosis, and treatment—both dialytic and non-dialytic—of pediatric AKI.

Key Points

  • Over the past 20 years, the main causes of pediatric acute kidney injury (AKI) in developed countries have changed from infectious diseases to ischemia, toxicity, nephropathy, and sepsis

  • The flaws of and lack of agreement on current definitions of AKI make it difficult to ascertain the exact incidence of this condition in children

  • Conservative management of AKI with agents such as diuretics, nesitiride, and fenoldopam might be effective in adults, but data are lacking in children

  • No studies have prospectively compared the various types of acute renal replacement therapy, although many centers favor continuous hemofiltration

  • The diagnosis, treatment, and outcomes of pediatric AKI might be improved with the use of biomarkers such as urinary neutrophil gelatinase-associated lipocalin

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Author notes

  1. Helen DeVos Children's Hospital, 221 Michigan Street NE, Suite 406, Grand Rapids, MI 49503, USA timothy.bunchman@devoschildrens.org

Authors and Affiliations

  1. TE Bunchman is a Professor and Director of Pediatric Nephrology, Dialysis and Transplantation at the Helen DeVos Children's Hospital in Grand Rapids, MI, USA.,

    Timothy E Bunchman

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  1. Timothy E Bunchman
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Competing interests

The author has received grant/research support from Dialysis Solutions Inc and Gambro Healthcare.

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Bunchman, T. Treatment of acute kidney injury in children: from conservative management to renal replacement therapy. Nat Rev Nephrol 4, 510–514 (2008). https://doi.org/10.1038/ncpneph0924

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  • DOI: https://doi.org/10.1038/ncpneph0924

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