Advances in the Diagnosis and Treatment of Pediatric Sepsis-Associated Acute Kidney Injury

Sepsis remains a leading cause of mortality among critically ill children in pediatric intensive care units (PICUs) worldwide. A frequent and severe complication is sepsis-associated acute kidney injury (SA-AKI), which increases morbidity and mortality, and contributes to the development of long-term chronic kidney disease. Recent advancements have expanded our understanding of pediatric SA-AKI, revealing a complex pathophysiology driven by systemic inflammation, microcirculatory dysfunction, reprogramming of energy metabolism, and programmed cell death. Besides, the emergence of novel biomarkers and risk stratification models has improved early detection and subphenotype classification. Despite these strides, traditional diagnostic criteria that rely on serum creatinine and urine output often delay diagnosis and exhibit limited ability to capture disease heterogeneity, thereby hindering the timely implementation of targeted, individualized therapies. This review synthesizes the latest evidence on pediatric SA-AKI, focusing on its pathophysiology, evolving diagnostic criteria, and the identification of clinical subtypes. Furthermore, it highlights precision medicine strategies, including novel biomarkers, advanced risk prediction models, and targeted interventions, to provide a theoretical foundation for future clinical research and personalized treatment.