Management of Acute Kidney Injury

Acute kidney injury is common in hospitalized children and is associated with siginficant morbidity and mortality especially in critically ill children. A complete evaluation is necessary for all children with AKI as early recognition and treatment is paramount. Apart from clinical evaluation, urinalysis, biochemical investigations and imaging studies helps in the diagnosis of the specific cause of AKI and assessing its severity. Attention should be given to assessment of volume status and fluid administration because volume depletion is a common and modifiable risk factor for AKI. Prevention or prompt management of complications like fliud overload, hyperkalemia and metabolic acidosis improves outcomes. Immediate initiation of renal replacement therapy (RRT) is indicated in the presence of life threatening changes in fluid, electrolyte and acid-base balance. Other measures like treating the underlying cause of AKI, adapting dosage of drugs to renal function, treatment of infections and providing adequate nutrition is important. Children with AKI should be followed up as they are at risk for development of chronic kidney disease.