Use of NGAL for Fluid Dosing and CRRT Initiation in Pediatric AKI

In the pediatric population, acute kidney injury (AKI) is commonly observed in critically ill
patients. At this time, there are no standardized care pathways that begin at identifying
patients at risk for developing AKI and progress through to early recognition and treatment.
Through previous work, the investigators have developed, tested, and integrated an AKI
risk-stratification/clinical recognition tool (RAI) and a urine biomarker (NGAL) to try to
identify patients at risk vs. not at-risk for developing AKI. However, these factors alone
have yet to be integrated into clinical decision support to optimize AKI therapies and
patient outcomes. The furosemide stress test (FST), previously described in adults, may be a
good predictor for the patients who need acute dialysis for AKI versus those that can be
managed medically.

Through this study, the investigators will be following a cohort of patients admitted to the
PICU who are identified as being at risk for developing AKI through RAI and NGAL results. The
aim is to standardize the FST in this population, as well as determine the accuracy of the
RAI-NGAL-FST clinical decision tool in predicting patients who become fluid overloaded and
develop AKI.

Inclusion Criteria:

- Admitted to the Pediatric Intensive Care Unit (PICU)

- Renal Angina Index (RAI) greater than or equal to 8

- Urine NGAL greater than or equal to 150 ng/mL

- Indwelling urinary catheter

Exclusion Criteria:

- Evidence of volume depletion

- Baseline Chronic Kidney Disease (CKD) Stage IV or V (estimated GFR <60 mL/min/1.73m2)

- History of kidney transplantation

- Active DNR order or clinical team is not committed to escalating medical care

- Known history of allergic reaction to furosemide (only for FST)