Pediatric acute kidney injury: it's time for real progress

Mortality and morbidity from acute renal failure has not improved in pediatric or adult patients over the past 40 years. This lack of improvement stems from varied definitions for acute renal failure (ARF), changes in ARF epidemiology, and the reliance on changes in serum creatinine for ARF diagnosis. Significant research has occurred in the past 5 years to standardize ARF definitions, recognize ARF earlier, discover urinary biomarkers of early renal insult, and more optimally manage patients with ARF. As a result, changes in nomenclature from ARF to acute kidney injury and earlier institution of renal replacement therapy may lead to improvements in patient outcome. The aim of this editorial is to provide a description of the state of the art in pediatric ARF diagnosis and management by highlighting recent significant clinical and research progress.