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<< Acute Kidney Injury in Pediatric Patients: Diagnosis and Management in the Emergency Department (Pharmacology CME)

Diagnostic Studies

Laboratory Studies

Serum Creatinine

Given the potential progression of AKI in critically ill children, early identification is crucial.5,23 An increase in SCr is currently the gold-standard biomarker of AKI, as a rise in SCr is associated with a decreased GFR. However, SCr has shortcomings as a biomarker, particularly in the pediatric population in which baseline creatinine may be unknown or may be low enough such that a rise in value may remain within the normal range for age. Additionally, creatinine testing is not sensitive in the early phase of AKI; creatinine may not rise for up to 48 hours after initial insult or until up to 50% of kidney function has been lost,64 as kidney reserve function must first be overwhelmed before a rise in SCr occurs. Creatinine is also sensitive to differences in muscle mass, gender, hydration status, and age.65 (See Table 4.) Moreover, as a spot value in the acute setting, SCr measurement may provide false reassurance, as there may not be a baseline value for comparison. For example, if a 3-year-old boy has an undocumented baseline SCr level of 0.3 mg/dL, then an acute rise by 100% would remain within the reference range for age.

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