Improving pediatric post-acute kidney injury care: considerations for the clinician

Abstract Acute kidney injury (AKI) is a frequent complication among hospitalized children, particularly during critical illness, and is associated with higher mortality rates and prolonged hospitalization. Accumulating evidence indicates that the consequences of pediatric AKI extend beyond the acute hospitalization and have strong associations with subsequent adverse kidney outcomes and hypertension. A review of the pediatric literature reveals a paucity of data defining the optimal timing, frequency, and components of post-AKI follow-up in children to mitigate long-term morbidity. In this review, we will address the potential sequelae of AKI among hospitalized children, including the temporal spectrum of acute kidney disease and chronic kidney disease. We will further discuss risk factors associated with adverse long-term outcomes and recommended follow-up surveillance after childhood AKI. In addition, we will review emerging biomarkers that may help identify children at higher risk for adverse outcomes following AKI.