Defining pediatric community-acquired acute kidney injury: an observational study

Pediatr Res. 2020 Feb;87(3):564-568. doi: 10.1038/s41390-019-0577-3. Epub 2019 Sep 19.


Background: Pediatric acute kidney injury (AKI) is associated with long-term morbidity and mortality; however, outcomes improve when AKI is detected earlier. Current definitions of AKI use baseline creatinine; community-acquired AKI (CA-AKI) is difficult to define and detect in the pediatric emergency department (ED) when no baseline creatinine is available. Our objective was to compare age- and gender-based creatinine norms to the traditional baseline (lowest creatinine in previous 3 months) to diagnose CA-AKI.

Methods: This was a retrospective cross-sectional study conducted in children 1 month-18 years of age seen in the pediatric ED in whom a creatinine was obtained.

Results: Per the Kidney Disease Improving Global Outcomes AKI definition in encounters with baseline creatinine available, 343/2338 (14.7%) had CA-AKI. When the upper limit of the age- and gender-based creatinine norm was applied as a surrogate baseline creatinine, CA-AKI was diagnosed in 1.5% of encounters (239/15,486). Additionally, CA-AKI was diagnosed in 178 cases using the upper limit of age- and gender-based creatinine norms only, as these cases did not have a baseline creatinine.

Conclusions: Age- and gender-based creatinine norms can be applied as a surrogate baseline to detect CA-AKI in all children regardless of whether baseline creatinine is available, potentially detecting it earlier.

Publication types

  • Observational Study

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / diagnosis*
  • Adolescent
  • Age Factors
  • Biomarkers / blood
  • Child
  • Child, Preschool
  • Creatinine / blood*
  • Cross-Sectional Studies
  • Early Diagnosis
  • Female
  • Humans
  • Infant
  • Kidney Function Tests* / standards
  • Male
  • Predictive Value of Tests
  • Reference Values
  • Retrospective Studies
  • Sex Factors


  • Biomarkers
  • Creatinine