RT Book, Section
A1 Arikan, Ayse Akcan
A1 Devarajan, Prasad
A2 Kline, Mark W.
SR Print(0)
ID 1182912418
T1 Acute Kidney Injury
T2 Rudolph's Pediatrics, 23e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259588594
LK accesspediatrics.mhmedical.com/content.aspx?aid=1182912418
RD 2024/04/19
AB Acute  kidney  injury  (AKI)  is  “an  abrupt  (within  48  hours)  reduction  in  kidney  function  defined  as  an  absolute  increase  in  serum  creatinine  by  >  0.3  mg/dL  or  a  relative  increase  of  >  50%  from  baseline,  or  oliguria  of    6  hours.”  This  definition  has  replaced  the  old  term  acute  renal  failure,  classically  hallmarked  by  a  sudden  and  rapid  decline  in  glomerular  filtration  rate  (GFR),  leading  to  accumulation  of  nitrogenous  wastes  such  as  blood  urea  nitrogen  (BUN)  and  creatinine.  This  change  has  been  the  result  of  a  deliberate  campaign  by  experts  in  the  field  to  underscore  the  association  of  even  subtle  disturbances  in  renal  function  with  adverse  outcomes,  while  emphasizing  that  AKI  is  a  continuum  on  a  spectrum  from  subclinical  renal  injury  to  full-blown  complete  failure  with  total  loss  of  kidney  function.  Even  small  increases  in  serum  creatinine  are  now  recognized  as  contributing  to  poor  outcomes.  In  adults,  an  increase  in  serum  creatinine  of  only  0.3  mg/dL  was  associated  with  increased  mortality  rates,  even  when  controlling  for  significant  patient  comorbidity.  Similar  results  were  noted  in  pediatric  patients  with  acute  decompensated  heart  failure,  in  whom  a  0.3-mg/dL  or  greater  rise  in  serum  creatinine  demonstrated  a  7-fold  increased  risk  of  mortality.  These  findings  highlight  the  need  for  a  focus  on  earlier  detection  and  treatment  of  AKI,  well  before  the  serum  creatinine  begins  to  rise  and  other  nonrenal  complications  ensue.  With  improved  understanding  about  incomplete  recovery  from  AKI  episodes  leading  to  chronic  kidney  disease  (CKD)  and  the  independent  mortality  and  morbidity  risk  that  AKI  poses  in  hospitalized  adults  and  children,  AKI  is  now  seen  as  a  public  health  threat.  Unfortunately,  there  are  no  satisfactory  therapeutic  options.