• Renal insult common in PICU patients
  • Injury usually within first week of admission
  • Early recognition is important
  • Pay attention to urine output and Bun/Cr numbers
  • Acute Kidney Injury is an independent risk factor for M & M
  • Adjust doses of medications for renal function
  • Pay attention to fluid balance in renal patients
  • Insensibles (15-20%) plus output should be maintenance fluid requirement
  • Higher dose of diuretics may be needed to convert from oliguric to non oliguric renal failure
  • Fluid overload (20%) is an independent risk factor for M & M

Transplant patients

  • Co-managed by transplant surgeons and nephrology
  • Protocol established and available for all patients
  • Ensure patient has adequate CVP and urine output
  • Notify fellow and surgery for any changes in urine output
  • Renal ultrasound with Doppler to investigate any vascular accidents in transplanted kidney
  • Check Immunosuppression regimen with nephrology


  • Systemic acidosis with alkaline urine
  • A/w acidosis and dyselectrolytemia
  • Needs Bicarb therapy for correction
  • Electrolyte monitoring and replacement may be needed

Pediatric-modified RIFLE (pRIFLE) criteria

Category Estimated Cr Cl Urine Output
Risk eCCl decrease by 25% 0.5 ml/kg/h for 8 h
Injury eCCl decrease by 50% 0.5 ml/kg/h for 16 h
Failure eCCl decrease by 75% or
eCCl 35 ml/min/1.73m2
0.3 ml/kg/h for 24 h or
anuric for 12 h
Loss Persistent failure > 4 weeks  
End Stage End-stage renal disease
(persistent failure > 3 months)