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822 opportunities for pediatric palliative care Pediatrics 2004;114(3) e361–6 6 Jonsen AR The god squad and the origins of trans plantation ethics and policy J Law Med Ethics 2007;35(2) 238–40 7 Fried[.]

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AMA J Ethics 2015;17(10):909–13 98 Schowalter JE, Ferholt JB, Mann NM.  The adolescent patient’s decision to die Pediatrics 1973;51(1):97–103 99 Ross LF. Against the tide: arguments against respecting a minor’s refusal of efficacious life-saving treatment Camb Q Healthc Ethics 2009;18(3):302–15; discussion 15–22 100 Tate T, Goldberg A, Wightman A, Warady BA, Lantos JD. Controversy about dialysis for an adolescent Pediatrics 2017;140(1):e20170327 Part VIII Special Indications, Techniques and Applications Diagnosis and Treatment of Acute Kidney Injury in Children and Adolescents 43 Emma Heydari Ulrich, David Selewski, and Michael Zappitelli Introduction Diagnosis of Acute Kidney Injury In the past 15 years, understanding of acute kidney injury (AKI) has replaced past perceptions of acute renal failure, reflecting a growing appreciation of AKI as a dynamic, graded pathologic process associated with significant morbidity and mortality Significant effort is being made to increase knowledge of AKI pathophysiology and develop predictive models and biomarkers to advance treatments and improve outcomes In parallel, renal support therapy (RST) has expanded from a “last resort” treatment to an important tool to prevent AKI complications and improve kidney outcomes The last decade has also been marked by improved RST technology for small patients Definition of AKI E H Ulrich Division of Nephrology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada e-mail: eheydari@ualberta.ca D Selewski (*) Department of Pediatrics, Division of Pediatric Nephrology, Medical University of South Carolina, Charleston, SC, USA e-mail: selewski@musc.edu M Zappitelli Division of Nephrology, Department of Pediatrics, Toronto Hospital for Sick Children, University of Toronto, Toronto, ON, Canada Until recently, a major obstacle to understanding pediatric AKI epidemiology was the lack of a standardized definition Since 2005, several definitions have been proposed, based on acute serum creatinine (SCr) rise and urine output (UO) decrease to grade AKI severity [1] Development of these simple, categorical definitions led to a surge of AKI epidemiological studies, initially in adults and more recently in children [2–4] The most recent and internationally accepted AKI definition is that of the Kidney Disease: Improving Global Outcomes (KDIGO) AKI work group (2012) [5] (Table 43.1) Initially developed for use in adults, the KDIGO definition incorporates pediatric-specific criteria There is also a modified neonatal version (Chap 44) [3, 6] The KDIGO definition has been applied and shown to have strong associations with clinical outcomes, including mortality, in many pediatric populations, including the multinational Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology (AWARE) study in critically ill children [2] The AWARE study highlighted that both the SCr and UO components of the KDIGO definition are important and should be monitored closely in at-risk patients A major limitation of these definitions remains the low sensitivity and specificity of SCr and UO measures [5] SCr concentration is affected by muscle © Springer Nature Switzerland AG 2021 B A Warady et al (eds.), Pediatric Dialysis, https://doi.org/10.1007/978-3-030-66861-7_43 827 E H Ulrich et al 828 Table 43.1  KDIGO definition of acute kidney injury in children [5] KDIGO Serum creatinine criteria Stage ≥1.5–1.9× baseline rise within 7 days OR ≥26.5 μmol/L (≥0.3 mg/dL) rise within 48 h ≥2.0–2.9× baseline ≥3.0× baseline OR Serum creatinine ≥353.7 μmol/L (≥4.0 mg/dL) OR In patients

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