Monitoring kidney function in the pediatric intensive care unit

Catherine D. Krawczeski*, Stuart L. Goldstein, Rajit K. Basu, Prasad Devarajan, Derek S. Wheeler

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Scopus citations

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 languageEnglish (US)
Title of host publicationPediatric Critical Care Medicine
Subtitle of host publicationVolume 1: Care of the Critically Ill or Injured Child, Second Edition
PublisherSpringer-Verlag London Ltd
Pages603-617
Number of pages15
ISBN (Electronic)9781447163626
ISBN (Print)9781447163619
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Keywords

  • Acute kidney injury
  • Biomarkers
  • Cystatin C
  • Fluid overload
  • IL-18
  • KIM-1
  • NGAL
  • Renal angina

ASJC Scopus subject areas

  • Medicine(all)

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