Managing babies, children, and young people (BCYP) with AKI in primary care

How does AKI differ in children from adults?

Children’s creatinine changes with age, and depends on how big they are and how much muscle mass they have. So, the interpretation of a creatinine value must take this into account.

Children with a creatinine above the acceptable range may have chronic kidney disease (CKD) or they may have AKI.

Certain children 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). Children 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.

Children 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
• History of taking medication that may adversely affect renal function (ACEI/ARB, NSAIDs, aminoglycosides, calcineurin inhibitors)

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

• History of reduced urine output
• Sepsis
• Hypoperfusion or dehydration
• History of exposure to drugs or toxin that may adversely affect renal function
• Renal disease or urinary tract obstruction
• Major surgery