Acute Kidney Injury | Diagnosis & Treatments

How we diagnose acute kidney injuries in children

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:

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.

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.

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.

What are the treatment options for an acute kidney injury?

Treatment for acute kidney injury (AKI) usually involves three components:

Stabilizing your child’s health

To do so your child’s doctors may:

  • treat your child with diuretics and/or intravenous (IV) fluids to rebalance the fluids and minerals in her blood
  • treat infections with antibiotics
  • stabilize the blood pressure

Treating the underlying cause of your child's acute kidney injury

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

Supporting your child’s kidneys as they recover

  • close monitoring of important electrolytes such as potassium, sodium and calcium, which may also be replaced through an IV
  • medication to control blood pressure or prevent infections
  • specific diet requirements to limit the amount of toxins in your child’s bloodstream as the 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. Learn 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.

What’s the long-term outlook for a child with an acute kidney injury?

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.