- Confirm this is a child (≥1 month, <18 years). Neonates (<28 days) use the modified neonatal-KDIGO criteria — not this tool.
- Choose the classification: pRIFLE (Akcan-Arikan 2007) or pKDIGO (KDIGO 2012 pediatric).
- Enter the patient's baseline serum creatinine (mg/dL) and current serum creatinine (mg/dL). When height (cm) and sex are entered, the calculator also reports the bedside-Schwartz eCCl (= 0.413 × height / SCr, mL/min/1.73 m²) used by pRIFLE.
- Enter the urine output (mL/kg/hr) averaged over the relevant assessment window.
- The calculator returns the worst-of stage from (a) the SCr/eCCl criterion and (b) the urine-output criterion, with the basis shown explicitly.
All computation runs in your browser; no values are stored or transmitted.
When to Use
Use this tool to stage acute kidney injury in children (≥1 month and <18 years) at the bedside or in the chart, by either pRIFLE or pKDIGO. Both staging systems integrate (1) a renal-function criterion — a change in serum creatinine (pKDIGO) or in estimated creatinine clearance (pRIFLE) from baseline — and (2) a urine-output criterion. The final stage is the worst of the two; either criterion alone is sufficient to assign a stage. Use it whenever you need a reproducible, auditable classification of pediatric AKI severity (e.g. for prognostication, fluid and nephrotoxin decisions, or when documenting an AKI episode).
Appropriate population
Hospitalized children and adolescents (≥1 month to <18 years) with suspected or confirmed AKI, where a baseline serum creatinine (measured or reasonably estimated) and a contemporaneous urine output (mL/kg/hr) are available. Especially useful in PICU patients, post-operative cases, sepsis, contrast or nephrotoxin exposure, and any inpatient whose creatinine has risen acutely.
When NOT to apply it
Neonates (<28 days) require the modified neonatal-KDIGO criteria, which use absolute SCr thresholds and lower urine-output cut-offs because of physiologic immaturity — do not stage neonates with this tool. The classification also assumes the SCr is not artefactually altered (rhabdomyolysis, large muscle mass, severe malnutrition, drugs that block tubular creatinine secretion); in patients on RRT the criterion is met by definition. Both systems require a baseline SCr — if none exists, back-calculation methods carry uncertainty and the stage should be interpreted accordingly.
Pearls & Pitfalls
pRIFLE vs. pKDIGO — both, not one
pRIFLE was the first pediatric-specific AKI classification (Akcan-Arikan, 2007) and is built around estimated creatinine clearance change from baseline (bedside Schwartz). pKDIGO is the pediatric adaptation of the global KDIGO 2012 framework and is built around SCr ratio change and an absolute SCr threshold; it harmonizes pediatric and adult definitions. Modern practice favors pKDIGO, but pRIFLE remains in widespread clinical and research use — clinicians should be fluent in both, which is why this tool reports either on demand.
Always pair the stage with urine output AND clinical context
Pediatric AKI is staged by the worst of the SCr/eCCl criterion and the urine-output criterion — never by one in isolation. Serum creatinine lags the actual change in GFR by hours-to-days, so urine output is often the earlier signal, and a "Stage 1" by SCr in an oliguric, fluid-overloaded child can already be a clinically severe AKI. Pair the stage with the cause, fluid balance, and trajectory before acting on it.
Baseline SCr is often estimated
A true baseline SCr is frequently unavailable. A common back-calculation assumes a normal eGFR-for-age (e.g. 120 mL/min/1.73 m²) and solves Schwartz for SCr at the patient's current height; an alternative uses the lowest pre-admission SCr in the last 3–12 months. Both approaches introduce uncertainty — note explicitly when a baseline is estimated, and re-stage when the true baseline becomes known.
Do not use in neonates
Neonates (<28 days) require the modified neonatal-KDIGO classification — different SCr cut-offs and a lower urine-output threshold (<1 mL/kg/hr at varying durations) — because physiologic SCr falls during the first weeks of life and oliguria has a different baseline. Do not apply pRIFLE or pKDIGO to neonates with this tool.
Why Use It
Acute kidney injury in hospitalized children is common (around 1 in 4 PICU admissions in modern cohorts) and is independently associated with longer length of stay, more mechanical ventilation, more RRT, and higher mortality — and the risk rises with stage. A standardized, reproducible stage at the bedside makes it possible to trend the same patient over hours and days, compare across providers and shifts, and pull the right downstream levers (review nephrotoxic drugs, weight-based fluid plan, dose adjustment, contrast avoidance, nephrology consult, RRT readiness). pRIFLE and pKDIGO are the two pediatric standards used for this; this calculator returns both on demand so a clinician can stage a child in seconds and document the basis (SCr/eCCl vs. urine output) for the chosen category.
Pediatric AKI Staging — pRIFLE & pKDIGO
Choose the classification, enter baseline and current serum creatinine (height/sex enable the Schwartz eCCl used by pRIFLE), and enter urine output. The stage is reported as the worst of the SCr/eCCl criterion and the urine-output criterion.
⚕ pRIFLE — Akcan-Arikan A, et al. Kidney Int. 2007;71(10):1028–1035. pKDIGO — KDIGO AKI Work Group. Kidney Int Suppl. 2012;2(1):1–138. Schwartz eCCl uses the bedside formula (k = 0.413 × height / SCr). Neonates (<28 d) require neonatal-KDIGO criteria, not this tool. For licensed clinicians; staging does not substitute for individualized assessment.
Next Steps
Once a stage is assigned, take stage-appropriate action and re-stage as the SCr and urine output evolve.
- No AKI: continue surveillance with daily SCr and weight-based fluid balance if exposed to nephrotoxins, hypotension, sepsis, or contrast.
- Risk / Stage 1: review every nephrotoxin (aminoglycosides, NSAIDs, ACEi/ARB, vancomycin, amphotericin, contrast), correct hypovolemia, optimize hemodynamics, dose-adjust drugs for the current eGFR, and recheck SCr within 12–24 h.
- Injury / Stage 2: as above plus a formal pediatric nephrology consult, daily inputs/outputs and weights, electrolytes (K⁺, Ca²⁺, PO₄³⁻, HCO₃⁻) at least daily, and an early conversation with the family about trajectory.
- Failure / Stage 3: prepare for RRT — assess for hyperkalemia, severe acidosis, fluid overload (especially >15% above admission weight), uremic complications. Establish vascular/peritoneal access plans early; do not wait for an absolute SCr or anuria threshold to consult RRT.
- Re-stage with every SCr and at each UO assessment window; the stage is dynamic.
- Pair with the adult AKI staging tool for transition-age patients and the bedside Schwartz eGFR calculator for dose adjustment.
Evidence & References
pRIFLE — Akcan-Arikan 2007 (worst-of)
| Stage | eCCl criterion (Schwartz) | Urine-output criterion |
|---|---|---|
| Risk | eCCl decrease ≥25% (current ≤75% baseline) | <0.5 mL/kg/hr × ≥8 h |
| Injury | eCCl decrease ≥50% | <0.5 mL/kg/hr × ≥16 h |
| Failure | eCCl decrease ≥75% OR eCCl <35 mL/min/1.73 m² | <0.3 mL/kg/hr × ≥24 h OR anuria × ≥12 h |
| Loss | Persistent Failure >4 weeks | |
| End-stage | Persistent Failure >3 months | |
pKDIGO — KDIGO 2012 pediatric (worst-of)
| Stage | SCr criterion | Urine-output criterion |
|---|---|---|
| 1 | SCr ≥1.5–1.9× baseline (within 7 days) OR increase ≥0.3 mg/dL within 48 h | <0.5 mL/kg/hr × 6–12 h |
| 2 | SCr ≥2.0–2.9× baseline | <0.5 mL/kg/hr × ≥12 h |
| 3 | SCr ≥3.0× baseline OR SCr ≥4.0 mg/dL OR eGFR <35 mL/min/1.73 m² (in <18 yo) OR initiation of RRT | <0.3 mL/kg/hr × ≥24 h OR anuria × ≥12 h |
Bedside Schwartz eCCl (used for pRIFLE here)
| Quantity | Formula |
|---|---|
| eCCl (mL/min/1.73 m²) | 0.413 × height (cm) / serum creatinine (mg/dL) |
| Baseline eCCl | 0.413 × height (cm) / baseline SCr (mg/dL) |
| % change | (current eCCl − baseline eCCl) / baseline eCCl × 100 |
Both systems assign the final stage as the worst of the SCr/eCCl criterion and the urine-output criterion. The tool reports the basis explicitly so the staging is auditable. Loss/End-stage (pRIFLE) require longitudinal follow-up beyond a single snapshot and are not auto-assigned here.
References
- Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71(10):1028–1035. doi:10.1038/sj.ki.5002231.
- Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2(1):1–138.
- Sutherland SM, Byrnes JJ, Kothari M, et al. AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol. 2015;10(4):554–561. doi:10.2215/CJN.01900214. (See also Sutherland SM, et al. AKI in hospitalized children: epidemiology and outcomes. CJASN. 2013;8(10):1661–1669.)
