Acute kidney injury in children, look for it and don't ignore it!

cute kidney injury (AKI), formerly known asacute renal failure (ARF) is an importantcontributor to mortality and morbidityespecially in critically ill children.Understanding the burden of AKI and its implication hasbeen hampered by the lack of a precise definition of AKI.More than 30 definitions in literature have led toreporting of wide variation in incidence and outcomes[1]. A minor acute reduction in kidney function (whichmay be clinically not apparent and may be just a subtlerise in serum creatinine) has been consistently shown tohave an adverse prognosis. Hence the term acute kidneyinjury (AKI) was proposed to encompass the entirespectrum not limited to those who need renal replacementtherapy (RRT). Two similar definitions based oncreatinine and urine output for diagnosis andclassification of AKI; the pediatric Risk, Injury, Failure,Loss, End-Stage Renal Disease criteria (pRIFLE) and theAcute Kidney Injury Network (AKIN) staging systemhave been proposed [2,3].The spectrum and burden of AKI in developingcountries may be different from that of developedcountries. The patients from developing countries areyounger, infection associated AKI is more common and asignificant proportion may have already developed AKIat the time of hospitalization. In addition resourcelimitations in managing children who require RRT add tothe burden.Mehta and her colleagues must be congratulated fortaking the first step toward understanding the naturalhistory of AKI in hospitalized children in our countryusing the AKIN criteria [4]. They observed that one thirdof critically ill children developed AKI in hospital and theincidence was four fold higher compared to the non-critically ill. The authors have validated findings fromworld wide literature that AKI is common. They haveshown that AKI occurs very early in hospitalization