Results: pRIFLE ⌬SCr and AKIN led to identical AKI distributions. pRIFLE ⌬CCl resulted in 14.5% (critically ill) and 11% (noncritical) more patients diagnosed with AKI compared to other methods (P 0.05). Different bSCr estimates led to differences in AKI incidence, from 12% (AdmSCr) to 87.8% (NormsMin) (P 0.05) in the critically ill group and from 4.6% (eCCl 100 ) to 43.1% (NormsMin) (P 0.05) in the noncritical group.Conclusions: AKI definition variation causes interstudy heterogeneity. AKI definition should be standardized so that results can be compared across studies.

Chylothorax is a significant problem in pediatric cardiac surgery and is associated with increased mortality, cost, and length of stay. Strategies should be developed to improve prevention and treatment.

SummaryBackground and objectives Acute kidney injury (AKI) in hospitalized children results in increased patient morbidity and mortality. Nephrotoxic-medication exposure is a common cause of AKI. Currently, no data exist to quantify the risks of developing AKI for various nephrotoxic medications in children. The primary aim of the current study is to assess for a potential association between nephrotoxic medications and the risk of developing AKI in hospitalized noncritically ill children with no pre-existing renal insufficiency. Design, setting, participants, & measurementsWe performed a retrospective case-control study in pediatric hospitalized noncritically ill patients aged 1 day to 18 years. The cases were patients who developed AKI, as defined by the pediatric modified RIFLE (pRIFLE) criteria; patients without AKI served as controls and were matched by age category, gender, and disease state.Results 561/1660 (33.8%) patients identified for inclusion had AKI (441 category "R," 117 category "I," three category "F"); 357 cases were matched with 357 controls. Patients with AKI had longer length of hospital stay and increased hospital costs. Patients with AKI had exposure to more nephrotoxic medications for a longer period of time compared with controls. Odds of exposure for at least one nephrotoxic medication was significant for development of AKI. Exposure to more nephrotoxic medications was associated with an increased risk of AKI.Conclusions Increasing exposure to three or more nephrotoxic medications places pediatric patients at greater risk of acute kidney injury with resultant increased hospital costs and patient morbidity.

AKI is common and associated with poorer outcomes in non-critically ill children treated with AG. Future research should attempt to understand how to best define AKI in the non-critical illness paediatric setting.