Pediatric Acute Care Nephrology

We provide a full range of renal (kidney) replacement therapies (RRT). These specialized forms of dialysis replace the kidneys' job of filtering waste and excess fluid from the blood. Children need RRT when the kidneys aren’t working properly because of acute kidney injury and other causes.

Our team works closely with ICU specialists to select the right type of RRT based on your child’s condition, size and overall health needs. We offer:

• Continuous renal replacement therapy (CRRT): This therapy provides continuous kidney support for children in the ICU. The care team uses CRRT to manage your child’s fluids and filter their blood, if needed. Children’s Health has all the most advanced CRRT machines, including Prismaflex, PrisMax and CARPEDIEM™, so we can treat children of all sizes.

• Prolonged intermittent renal replacement therapy (PIRRT): We use this therapy for children who no longer need continuous treatment but still need kidney support. Your child receives PIRRT for set periods of time, and we adjust the therapy as your child’s condition changes.

• Aquapheresis (ultrafiltration): Aquapheresis is another type of RRT used when the goal is to remove extra fluid from the body, not clean waste from the blood. We can treat even newborns with this therapy because the machine (the Aquadex® system) works more gradually to gently manage your child’s fluid balance.

• Continuous low-volume peritoneal dialysis: This gentle form of RRT also helps support your child’s kidneys when they aren’t working well. A special fluid flows in and out of the belly through a soft tube, helping remove extra fluid and waste.

We use this therapy, also called liver dialysis, when a child’s liver isn’t working well because of severe disease or poisoning. Extracorporeal means outside the body, and this therapy uses a machine to remove harmful substances from the blood. Extracorporeal liver support works similar to the way RRT removes waste when the kidneys aren’t working. Children’s Health is one of the few centers nationwide that offers molecular adsorbent recirculating system (MARS) therapy for liver support.

This therapy treats children who have acute kidney injury caused by sepsis (a severe immune reaction to an infection). We use a device called Quelimmune™ to deliver this treatment, and children receive it along with CRRT. This device works to calm certain immune cells that are causing too much inflammation. It works much like putting these overactive cells in “time-out.”

By helping to manage the body’s immune response, the treatment may reduce further damage and support recovery. Children’s Health is one of the few centers nationwide that offers extracorporeal immunomodulation.

Our acute care nephrology specialists use bedside assessments, imaging and lab tests to understand how your child’s kidneys are working and identify issues that need attention:

• Physical exam and vital signs: The care team closely checks your child’s vital signs and performs regular physical exams. These tests look for early signs of kidney stress or changes in your child’s overall health.

• Diagnostic imaging: Imaging tests such as renal ultrasound or abdominal X-ray show your child’s kidneys and nearby organs. These images can show changes in size, structure or fluid that may affect kidney function.

• Blood tests: Blood tests provide important information about your child’s kidney function and the balance of fluids and minerals in their body.

• Urinalysis: Urine tests help detect early signs of kidney stress or injury by showing how the kidneys are filtering urine. Children’s Health is one of a few children’s hospitals with a urine test for a biomarker that can signal damage to the kidney before kidney function declines.