Acute Kidney Injury in Pediatric Populations

Definitions and Diagnostic Criteria

• The pediatric-modified RIFLE (pRIFLE) criteria are used to define and stage acute kidney injury (AKI) in children, utilizing estimated GFR, rise in creatinine, or decrease in urine output 1, 2
• The pRIFLE criteria allow for imputation of baseline kidney function when no prior creatinine is available, assuming a normal GFR of 100 ml/min/1.73 m² and using the patient's height 2
• Small changes in serum creatinine may represent relatively large changes in actual GFR in pediatric patients compared to adults with underlying chronic kidney disease (CKD) 3

Guideline Recommendations

• The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines refer to pRIFLE for the definition of AKI in children, acknowledging the need for separate criteria for the pediatric population 2
• The KDIGO and pRIFLE criteria have significant differences, requiring further validation before adoption of KDIGO criteria into pediatric research and practice 4

Epidemiology

• The causes of AKI differ significantly between high-income countries and low/lower-middle-income countries, with high-income countries typically experiencing AKI in hospital settings secondary to cancer treatments or elective surgeries, and low/lower-middle-income countries experiencing AKI secondary to infections or envenomation 5
• AKI in low/lower-middle-income countries disproportionately affects children and adolescents and is associated with significant morbidity and mortality 5