Skip to Main Content




The term “acute renal failure” (ARF) for alteration in kidney function in an acute setting was first introduced by Smith1 to define changes in kidney function due to traumatic injuries. Since the kidney's physiological role is the excretion of water-soluble solutes and urine production, changes in these parameters are often included in the definition of ARF. However, since the magnitude of changes is not uniformly defined, there is a large ascertainment bias when epidemiology of ARF is examined. For example, in a pediatric intensive care unit (PICU) study that defined ARF as doubling of serum creatinine (Cr), the incidence of ARF in all children admitted to the PICU was reported as 4.5%. However, in another PICU study that defined ARF as elevation of serum Cr to 1.5 times the normal value, the incidence of ARF was 82% in children with severe illness .2,3 This discrepancy led to the adoption of a consensus definition of ARF by the Acute Dialysis Quality Initiative. The objective was to arrive at a definition of ARF that uses standardized terminology and includes a broad range of acute impairment of renal function. This definition is referred by the acronym RIFLE,4 which stands for risk, injury, failure, loss of function, and end-stage renal disease (ESRD). These criteria have been modified in children to account for normal variations in serum Cr with somatic growth, referred to as pRIFLE (Table 14-1).3

Table Graphic Jump Location
Table 14-1.  

Pediatric RIFLE (pRIFLE) Criteria3




In the past, the etiologies of ARF in the pediatric hospital setting were limited to primary renal diseases such as hemolytic uremic syndrome and acute glomerulonephritis. However, ARF is now more likely secondary to systemic illness or its treatment, such as sepsis, nephrotoxic medications, and ischemia due to other organ involvement.3,5 Acute renal failure in the current intensive care setting is due to multiple organ dysfunction syndrome (MODS) following cardiopulmonary bypass surgery for congenital heart disease, liver failure, or stem cell transplantation. This poses difficult challenges in prescribing fluid and meeting nutrition needs, since each of these conditions has unique requirements.




Pediatric ARF has a definite and serious impact on both short-term and long-term outcomes. Previous thinking was that children in the PICU would ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.