Paediatrics

Overview

This section provides practical guidance for clinicians managing babies, children, and young people (BCYP) who are at risk of, or develop, acute kidney injury (AKI) across primary, secondary, and tertiary care.

AKI is a major patient safety issue in paediatrics as well as adults. NICE guidance emphasises early recognition and proactive identification of higher-risk groups, including children and young people (NG148). In BCYP, AKI most often occurs secondary to acute illness—commonly sepsis, hypovolaemia, hypotension, or peri-operative risk causing renal hypoperfusion, and/or exposure to medicines that are directly nephrotoxic or that alter renal haemodynamics—rather than from direct kidney trauma.

Paediatric AKI can be clinically silent early on and may only become apparent through routine blood testing or careful monitoring of urine output. Interpretation is more complex than in adults because baseline creatinine varies with age, size, and muscle mass, and newborn physiology adds further complexity. For this reason, this section includes paediatric reference ranges, guidance on interpreting AKI warning scores in context, and clear prompts for when repeat testing, escalation, or specialist discussion is appropriate.

Although much of the epidemiological literature relates to adults, AKI in BCYP is increasingly recognised as clinically important due to its association with acute deterioration, prolonged hospital stay, and longer-term kidney vulnerability—particularly after severe or recurrent episodes, in neonates, and in children with pre-existing kidney or systemic disease.

The emphasis throughout is on reliable fundamentals: early identification of risk, prompt assessment of the child’s physiological status (especially fluid balance and perfusion), timely treatment of reversible causes, and minimising iatrogenic harm (including medicines optimisation). The “3Ms — Monitor, Maintain, Minimise” framework is used to support consistent, proportionate care and reduce avoidable harm and long-term effects.