Paediatric risk groups

Certain BCYP are at greater risk of AKI either because of pre-existing disease / risk factors or because they fall into an acute high-risk scenario (see below). BCYP at high risk of AKI or in a high-risk scenario should have their serum creatinine measured.

Steps should be taken to prevent AKI by adequately monitoring kidney function, maintaining adequate hydration and by minimising harm.

Minimisation of harm includes reviewing medication (see Medicines Optimisation) and using contrast media judiciously, particularly in those at higher risk of AKI.

BCYP at high risk of AKI include those with:

Nephro-urological, cardiac or liver disease
Malignancy and/or a bone marrow transplant
Dependence on others for access to fluids (e.g. neurodevelopmental delay with Percutaneous Gastrostomy (PEG) feeds)
History of taking nephrotoxic drugs (e.g. NSAIDs, aminoglycosides, calcineurin inhibitors)
History of taking drugs that alter renal haemodynamics (e.g. ACEI/ARB, NSAIDs)

Neonatal risk groups

Premature Neonates (< 32 weeks, < 1500g)
Term neonates with Hypoxic Ischaemic Encephalopathy (HIE)

Scenarios in which BCYP can be at high risk of AKI include:

History of reduced urine output
Sepsis
Hypoperfusion or dehydration
History of exposure to nephrotoxic drugs or toxins (e.g. NSAIDs, aminoglycosides, calcineurin inhibitors)
History of exposure to drugs that alter renal haemodynamics (e.g. ACEI/ARB, NSAIDs)
Pre-existing kidney disease or urinary tract obstruction
Major surgery
Decreased level of consciousness

The Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) study showed that the incidence of AKI was 30% in a cohort of 2,022 critically ill neonates with an adjusted odds of mortality of 4.6 (9). Critically ill term and late preterm infants with AKI have an increased risk of long-term kidney dysfunction and merit evaluation at NICU discharge with subsequent comprehensive kidney health assessments based on risk factors. Current research gaps and opportunities for improved care include identifying optimal pre-discharge planning approaches, examining the impacts of different aetiologies and severity of AKI on long-term kidney and overall health, exploring modification to current AKI diagnosis standards, and development of high-yield educational tools for families and providers (10).

How to recognise AKI and interpret AKI warning scores

What steps should be taken to prevent AKI?