Renal supportive therapy for pediatric acute kidney injury in the setting of multiorgan dysfunction syndrome/sepsis.

In the setting of sepsis and multiorgan dysfunction syndrome, the development of acute kidney injury can be an ominous event, particularly in the pediatric patient. In this setting, rapid initiation of renal supportive therapy is likely to positively impact on mortality rates. Therapeutic initiation and choice of dialytic modality are dependent on physician beliefs, as well as patient and organizational characteristics. Patient-specific factors including adequacy of nutrition provision, acuity of acute kidney injury, degree of uremia, and severity of fluid overload all must be taken into account during the decision on whether or not to initiate renal supportive therapies. In addition to the utilization of classical renal supportive modalities such as acute hemodialysis, peritoneal dialysis, and continuous renal replacement therapies, the increasing use of plasma exchange therapies and other alternatives are actively being explored for use in sepsis-associated acute kidney injury. This article reviews these concepts and current literature in the context of pediatric specific sepsis-associated acute kidney injury.