Acute Kidney Injury

Acute kidney injury (AKI) occurs commonly in neonates in the neonatal intensive care unit (NICU) and affects short-term outcomes, long-term outcomes, and survival, independent of the severity of illness and comorbidities. At particular risk are those infants who experience perinatal asphyxia, require cardiac surgery, necessitate extracorporeal membrane oxygenation (ECMO), or who are born extremely premature. Standardized, consensus-based definitions help better define and quantify AKI, and emerging studies suggest novel biomarkers may improve our ability to detect and diagnose AKI in the future. The causes of neonatal AKI are varied and include pre-renal azotemia, ischemic insult, nephrotoxic insult, or rarely, obstructive pathologies. Once established, there are no specific treatments for neonatal AKI. However, comprehensive supportive care is paramount and must include avoidance of further nephrotoxic and/or ischemic insults, avoidance of fluid overload, provision of appropriate nutrition, and therapies to promote or restore acid/base and electrolyte homeostasis. Kidney support with dialysis modalities, either peritoneal or hemodialysis, are becoming increasingly available for neonates as new technologies make this therapy safer and more effective. Here we provide an in-depth review of neonatal AKI epidemiology, pathophysiology, evaluation, and management.