The mainstays of AKI prevention and treatment include maintenance of renal perfusion by preservation of intravascular volume, avoidance of hypotension, and the careful consideration of nephrotoxic agent administration. There are no effective pharmaceutical agents to treat AKI itself.
When prerenal AKI is suspected, early fluid resuscitation by oral or IV hydration is considered the most critical aspect of therapy; however, well-powered data in pediatric patients is lacking. Notably, aggressive IV fluid resuscitation could be detrimental to patients with cardiac dysfunction. In a randomized controlled study of 224 adult ICU patients with sepsis, early fluid administration was shown to decrease the risk of AKI from 55% to 39% (P = .015).73 After a patient has been hemodynamically stabilized, the underlying etiology of renal injury should be quickly identified and treated accordingly.
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