KidsMD Health Topics

Acute Kidney Injury

  • "An important part of our success has been the fact that we're always asking ourselves "Is this the best we can do? Are there new things that we can do? Can we change things? Can we take the approach we're using and make it better? Can we take a brand new approach to these things?"

    William Harmon, MD, medical director, Kidney Transplant Program


    There are several things that might make your child’s kidneys suddenly stop working, including infections, disruption of blood flow, surgery or exposure to medications or other substances that are toxic to the kidneys. This is known as acute kidney injury (AKI).

    • AKI is often caused by a sudden decrease in blood and/or oxygen flow to your child’s kidneys.
    • Symptoms may appear over the course of hours or days.
    • AKI typically requires your child to stay in the hospital, but it’s very treatable and in the vast majority of cases the child’s kidneys recover.

    The Boston Children’s Hospital approach

    Our Division of Nephrology is the largest pediatric nephrology service in the United States. We care for patients with a wide range of kidney disorders, and we are home to the biggest dialysis and  kidney transplant program in New England dedicated to treating and caring for children.

    Our seven-bed dialysis unit is the only full-service pediatric dialysis unit in New England. If your child requires dialysis, our dialysis nurses, dieticians, tutors Child Life specialists, social workers, psychologists and pharmacists will do everything they can to make sure your child is comfortable during her treatments. Read more about dialysis.

    Boston children's caregivers know your child is a person, not just a patient, and we provide support services for your child and your family throughout all stages of treatment and recovery.

    Boston Children’s Hospital ranked first in treating kidney disorders

    Boston Children's Orthopedic Center has been ranked #1 in treating kidney disorders in the U.S.News and World Report.


  • When your child is diagnosed with acute kidney injury you may have a lot of questions:

    • What exactly is acute kidney injury?
    • What are the treatments?
    • How will it affect my child long term?

    We’ve tried to provide some answers to those questions here, and when you meet with our experts, we can fully explain your child’s condition and treatment options.

    Background on the kidney

    The kidney has three main functions:

    • Cleaning the blood – removing waste, toxins and extra fluid and maintaining the proper balance of chemicals and minerals
    • Regulating vitamins and minerals that help bone growth and development
    • Releasing hormones and vitamins that:
    1. Regulate the level of red blood cells produced by the body
    2. Help control blood pressure
    3. Regulate the amount of the body's nutrients including calcium and potassium

    Out of these functions, it’s the sudden inability to clean the blood that presents the biggest complication of AKI. If the blood isn’t being cleaned and filtered, harmful toxins may build up in the bloodstream and cause significant damage.

    What’s the difference between AKI and chronic kidney disease (CKD)?

    Although AKI and CKD each result in a loss of kidney function, they differ in causes, symptoms, progression and treatment approaches.





    Infection, medication exposure, surgery, trauma

    About half of all pediatric cases are the result of kidney or bladder abnormalities that are present at birth



    Very sudden onset, usually over hours or days

    CKD is often detected when a pediatrician notices protein in the urine during a routine test



    Kidneys fail rapidly


    Kidney failure could take days, months or years


    Treatment approaches

    Targeted to the underlying cause of the kidney failure

    Based on how well the kidneys are functioning and strongly focused on relieving symptoms


    Read more about chronic kidney disease.


    What causes AKI?

    AKI is often caused by a sudden decrease in blood and/or oxygen flow to your child’s kidneys. This could follow:

    • An accident
    • Surgery
    • A condition that obstructs blood flow, like cardiac arrest

    AKI may also occur if your child:

    • Takes certain medications that may be toxic to the kidneys
    • Injures her abdomen or back, like a bike-riding accident that results in a fall over the handlebars, or a skiing accident
    • Develops a sudden obstruction or blockage in her urinary tract, such as a kidney stone, that prevents urine from leaving her body
    • Contracts an infection such as hemolytic uremic syndrome (HUS), usually caused by the E. coli bacteria. The infection results in the blockage of the structures and blood vessels in the kidney
    • Is born with blood vessel abnormalities that cut off blood flow to her kidneys
    • Has another disease or condition that damages the kidneys, such as glomerulonephritis or lupus



    What are the symptoms of acute kidney injury?

    Symptoms of AKI come on suddenly, over the course of hours or days. They depend on the underlying cause, but some of the most common symptoms include:

    • Hemorrhage (heavy bleeding)
    • Fever
    • Rash
    • Bloody diarrhea
    • Severe vomiting
    • Abdominal pain
    • No urine output or high urine output
    • Pale skin
    • Edema (swelling of the tissues)
    • Swelling around the eye
    • Detectable abdominal mass

    If your child has these symptoms, she may be especially at risk of AKI if she has or has had any of the following:

    • History of recent infection
    • History of dehydration
    • History of recent surgery
    • History of taking certain medications
    • History of trauma
    • Exposure to heavy metals or toxic solvents


    Q: Is my child’s condition serious?

    A: AKI is a serious condition, but it's usually reversible, and kidney function can be restored once we determine—and fix—whatever is causing the problem.

    Q: Will my child’s kidneys recover completely?

    A: This depends on the extent of the injury. If there has been significant injury, some kidney function may be permanently lost. If, for example, your child is left with 80 percent kidney function after an episode of AKI, it will still have to do still the work of a fully functioning kidney. Working harder means the kidney is more at risk for the normal wear and tear that affects everyone’s kidneys. Even so, remember that many people live a healthy life with only one kidney.

    Q: How long will my child be hospitalized?

    A: This depends on the cause of your child’s AKI, how sick she is, and how she responds to treatment. We'll make sure that she is comfortable and keep you informed of her progress at all times.

    Q: When will my child’s kidneys regain their functioning?

    A: The length of time it takes to recover from an episode of AKI depends on many factors, including the cause, severity, how long it lasted and how much damage was done to the kidneys.

    Q: What’s the long-term outlook for my child?

    A: Most children with acute kidney injury get better. After an episode of AKI, your child should consider kidney care to be a permanent part of her health care routine. She should see her doctor and have her blood pressure checked and urine tested every year to make sure that her kidney function has not deteriorated. Her doctor may also recommend that she’s followed by a nephrologist (a doctor who specializes in kidneys).

    In some severe episodes of AKI, particularly if your child has another disease or condition, the kidneys may not gain back normal functionality, and your child may be a candidate for long-term dialysis and/or kidney transplant.


    Questions to ask your doctor

    There’s a lot of information to gather when your child is diagnosed with acute kidney injury. Here are some questions to get you started:

    • What caused my child’s AKI?
    • What’s the best treatment for her right now?
    • How much experience does this institution have in treating children with AKI?
    • What do I need to do now?

    "Helping Your Child With Medical Experiences: A Practical Parent Guide"

    Download our free booklet, “Helping Your Child with Medical Experiences: A Practical Parent Guide”. (Please note that Adobe Acrobat is required) and read about topics including:

    • Talking to your child about his condition
    • Preparing for surgery and hospitalization
    • Supporting siblings
    • Taking care of yourself during your child’s illness
    • Adjusting to life after treatment








  • Tests

    The first step in treating your child is forming an accurate and complete diagnosis, and in order to minimize damage to your child’s kidneys, it’s important that AKI be diagnosed early. The doctor may order tests including:

    1. Blood, urine and other tests to determine how well your child’s kidneys are functioning

    There are two main ways to measure your child’s kidney functioning: creatinine level and glomerular filtration rate (GFR).

    Creatinine is a waste product that the body makes daily in proportion to a person’s muscle mass. It can leave the body only through the kidneys, and levels can be checked through a simple blood test. If your child has AKI, we will see her creatinine level rise quickly.

    GFR (glomerular filtration rate) is a measurement of how efficiently your kidneys are able to filter your blood. Read more about the GFR test at Children’s Hospital Boston.


    2. Imaging tests to check for blockages in the urinary tract

    These tests might include:

    • abdominal x-ray: invisible electromagnetic energy beams produce images of internal tissues, bones and organs onto film
    • renal ultrasound (also called sonography): a painless, non-invasive test in which a transducer is passed over your child’s kidneys, producing sound waves that bounce off the kidney and transmit a picture on a video screen. The test can detect a mass, kidney stone, cyst or other obstruction or abnormality. Read more about ultrasounds.
    • nuclear medicine study: non-invasive, painless tests that can reveal important information about your child's health. Nuclear medicine uses short-lived radiopharmaceuticals and specialized cameras to create images of the human body. Read more about nuclear medicine studies.

    3. Kidney biopsy

    This is a procedure in which tissue samples are removed (with a needle or during surgery) from the kidney for examination under a microscope. Read more about biopsies.

    After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. Then we’ll meet with you and your family to discuss the results and outline the best treatment options.

    Keep family and friends up to date during your child’s treatment by creating a free Children’s CarePage.
  • A diagnosis of acute kidney injury can be frightening. But you can rest assured knowing that Boston Children’s physicians are considered among the best in their field, compassionate and committed to helping your child and family.

    At Boston Children's, treatment for acute kidney injury usually involves three components:

    1. Stabilizing your child’s health

    To do so your child’s doctors may:

    • Treat her with diuretics and/or intravenous (IV) fluids to rebalance the fluids and minerals in her blood
    • Treat infections with antibiotics
    • Stabilize her blood pressure

    2. Treating the underlying cause of your child's AKI
    This may include:

    • Removing an obstruction or blockage
    • Stopping any medications thought to be causing or contributing to the AKI
    • Using medication to treat the underlying cause

    3. Support your child’s kidneys as they recover. This may include:

    • Close monitoring of important electrolytes such as potassium, sodium and calcium. These may also be replaced through an IV.
    • Medication to control blood pressure and/or prevent infections
    • Specific diet requirements to limit the amount of toxins in your child’s bloodstream as her kidneys heal

    If your child’s AKI is quite severe, her doctors may recommend dialysis, a procedure that filters and rebalances your child’s blood so that her kidneys can rest and heal. Read more about dialysis. 

    Typically, your child will be weaned off dialysis as the kidneys repair themselves. In rare cases, after three months on dialysis, the kidneys still might not have regained function. This may indicate that the kidneys are unable to repair themselves enough to work properly, and your child’s doctor may recommend that she continue dialysis or begin to be evaluated for a kidney transplant.

    Coping and support

    From your first visit to Boston Children's, you’ll work with a team of professionals who are committed to supporting your child and family during treatment for AKI.

    Patient education: Our nurses are on hand to walk you through your child’s treatment and help answer any questions you may have. They will also reach out to you by phone, continuing the care and support you received while at Boston Children’s.

    Parent to parent: Want to talk with someone whose child has been treated for AKI or a similar condition? We can often put you in touch with other families who can share their experience.

    Faith-based support: If you and your family find yourself in need of spiritual support, we can connect you with the Boston Children’s chaplaincy. Our program includes nearly a dozen clergy representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions who will listen to you, pray with you and help you observe your own faith practices during your treatment experience.

    Social work and mental health professionals: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child’s diagnosis, stresses relating to coping with illness and dealing with financial difficulties.

    On our For Patients and Families site, you can read all you need to know about:

    • Getting to Boston Children’s
    • Accommodations
    • Navigating the hospital experience
    • Resources that are available for your family

    Integrative therapies

    Our patient-centered approach means that we want your child to not only get better, but also feel good along the way. Throughout the hospital, you¹ll find clinicians trained in therapies that can make your child feel more comfortable, learn to shift focus away from pain and enjoy some peaceful moments during what may be an anxious time. Read more about how acupuncture, guided meditation, guided imagery, Massage, Reiki and therapeutic touch could help your child.





  • Boston Children’s is home to the world’s most extensive research enterprise at a pediatric hospital. In our End Stage Renal Disease Program—which includes the dialysis unit and our Kidney Transplant Program—our treatment is influenced by our research.

    We also have a great number of partnerships with top research, biotech and health care organizations and we work together to improve kids’ health.

    One of these is the Transplant Research Center (TRC), which provides a rich environment for collaboration of scientists and physicians in the areas of transplantation and immunology.

    If your child has end-stage renal disease, dialysis can filter his blood, but not take over the other roles of the kidney, such as regulating the amounts of some important vitamins and minerals released into the bloodstream and controlling blood pressure. For that, your child needs to take medication and follow a special diet. Our researchers are currently involved in several clinical trials to assess the safety and efficacy of medications aimed at fulfilling this pharmaceutical component of treating end-stage renal disease.

    We’re committed to developing better anti-rejection medication with the goal of more successful transplants and fewer side effects. Read more about how Boston Children's doctor/researchers are at the forefront of the effort to produce better anti-rejection medication.

    Catching AKI early

    Michael Ferguson, MD, is collaborating with researchers at the Brigham and Women’s Hospital to discover biological markers—molecular signs that a condition is present—of acute kidney injury. This work aims to help us identify children with AKI more quickly, so that further damage to the kidney may be avoided. This research also aims to help us predict how the AKI will resolve in various situations.

    We currently participate in more NIH-sponsored pediatric kidney transplant research studies than any other program in the nation.

    Clinical and Translational Study Unit

    Read about a day in the life of the Clinical and Translational Study Unit at Boston Children’s

    Children speak:

    What’s it like to be a medical research subject?




    Clinical trials

    Read about a day in the life of the Clinical and Translational Study Unit at Children’s.


  • Nephrology

    Boston Children's Hospital
    300 Longwood Avenue
    Boston MA 02115


Request an Appointment

If this is a medical emergency, please dial 9-1-1. This form should not be used in an emergency.

Patient Information
Date of Birth:
Contact Information
Appointment Details
Send RequestIf you do not see the specialty you are looking for, please call us at: 617-355-6000.International visitors should call International Health Services at +1-617-355-5209.
Please complete all required fields

This department is currently not accepting appointment requests online. Please call us at: 617-355-6000. International +1-617-355-6000.

This department is currently not accepting appointment requests online. Please call us at: 617-355-6000. International +1-617-355-6000.

Thank you.

Your request has been successfully submitted

You will be contacted within 1 business day.

If you have questions or would like more information, please call:

617-355-6000 +1-617-355-6000
Find a Doctor
Search by Clinician's Last Name or Specialty:
Select by Location:
Search by First Letter of Clinician's Last Name: *ABCDEFGHIJKLMNOPQRSTUVWXYZ
Condition & Treatments
Search for a Condition or Treatment:
View allSearch
The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO