Acute Kidney Injury and Chronic Kidney Disease

• Acute kidney injury (AKI) is common in critically ill neonates. AKI affects survival, hospital expenditures, and long-term outcomes, independent of severity of illness and comorbidities. • Renal development continues until 34 weeks' gestation. Neonatal intensive care unit graduates, especially those with AKI, premature infants, and those with intrauterine growth retardation, are at risk for long-term chronic kidney disease (CKD). • Clinical sequelae of CKD include anemia, acidosis, electrolyte abnormality, growth restriction, renal osteodystrophy, fluid overload, hypertension, and uremia. Attention to these complications is critical to optimizing long-term outcomes. • Long-term survival of neonates with end-stage renal disease (ESRD) appears to be approaching that of older infants and young children, but they continue to have higher morbidity and mortality due to infectious and cardiovascular complications. • Renal replacement therapy can be performed in neonatal patients and is likely to improve outcomes in children with AKI and those with ESRD.