Abstract
The kidneys play a principle role in homeostatic balance. Acute kidney injury (AKI) carries numerous sequelae both obvious and subtle which, in combination, increase the morbidity and mortality of pediatric patients. Recent standardization of diagnostic criteria has resulted in a heightened awareness of AKI, increased AKI incidence, and recognition of the deleterious impact of AKI. Since no singular therapy for established AKI exists, a determinant of effective AKI therapy is expeditious diagnosis. In critically ill children, these therapies and the institution of concurrent supportive and preventive care depends on the ability to accurately monitor the kidney and specifically detect the presence of kidney dysfunction. Unfortunately, diagnosis of AKI is traditionally reliant on numerous tests and monitors of kidney function which carry different degrees of precision and accuracy. Additionally, delay in AKI diagnosis can render potential AKI therapy ineffective and significantly limit alternative treatment options. In this chapter we will describe the epidemiology of AKI in pediatrics, the classic serum and urinary markers of kidney dysfunction, the impact of fluid overload, the limitations of classic markers of kidney function and several emerging AKI biomarkers, AKI risk stratification using renal angina, and the future of monitoring kidney function. Understanding these concepts is crucial to delivery of effective care for the critically ill child with AKI.
Original language | English (US) |
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Title of host publication | Pediatric Critical Care Medicine |
Subtitle of host publication | Volume 1: Care of the Critically Ill or Injured Child, Second Edition |
Publisher | Springer-Verlag London Ltd |
Pages | 603-617 |
Number of pages | 15 |
ISBN (Electronic) | 9781447163626 |
ISBN (Print) | 9781447163619 |
DOIs | |
State | Published - Jan 1 2014 |
Keywords
- Acute kidney injury
- Biomarkers
- Cystatin C
- Fluid overload
- IL-18
- KIM-1
- NGAL
- Renal angina
ASJC Scopus subject areas
- General Medicine