Table 1.

PODIUM: Criteria for Renal Organ Dysfunction in Pediatric Critical Illness

Organ system	Criterion for organ dysfunction	Suggested thresholds	Conditions	Severity
Renal	Urine outputa	<0.5mL/kg/h for ≥6 hours	Concomitant serum creatinine increase 1.5–1.9 times baselineb OR ≥0.3mg/dL (≥26.5 μmol/L) increase	Not graded
		<0.5mL/kg/h for ≥12 hours	None	Not graded
Renal	Serum creatinine	Increase 1.5–1.9 times baselineb OR ≥0.3mg/dL (≥26.5 μmol/L) increase	Concomitant urine outputa <0.5mL/kg/h for ≥6 hours	Not graded
		Increase ≥2 times baselineb	None	Not graded
Renal	eGFRc	decrease to <35mL/min/1.73m2	Excludes neonates <30 days of age	Not graded
Renal	Initiation of RRTd	NA	Initiation of RRT for any reason other than toxic ingestion or hyperammonemia	Not graded
Renal	Fluid overloade	20%	Measured starting 48 hours after ICUf admission	Not graded

^aConsider ruling out obstructive uropathy in the setting of low urine output

^bUse the lowest serum creatinine value available in the 3 months prior to admission as the baseline serum creatinine. If a prior serum creatinine is unavailable, baseline creatinine should be extrapolated from a normal eGFR for age and an appropriate estimating equation. In many critically ill children, heights are unavailable, making a height-independent equation preferential. Table 4 provides estimated baseline creatinine values based on a height-independent equation and normal reference eGFR for age. These creatinine values are derived from a healthy pediatric population³⁰ and have been validated in critically ill children²⁸.

^ceGFR: estimated glomerular filtration rate

^dRRT: renal replacement therapy

^eFluid overload (FO) can be calculated using intake and output or weight. For weight-based determination, $\text{FO}\text{=}\frac{\text{Current}\text{weight}\left(\text{kg}\right)-\text{ICU}\text{admission}\text{weight}\left(\text{kg}\right)}{ICUAdmissionweight\left(kg\right)}\times 100\%.$ For ins/outs based determination, $\text{FO}\text{=}\frac{\text{Cumulative}\text{fluid}\text{balance}\text{NET}\left(\text{fluid}\text{IN}-\text{fluid}\text{out}\right)}{ICUAdmissionweight\left(kg\right)}\times 100\%.$ Use of weight-based formula for fluid overload is preferential if weight data are available.

^fICU: intensive care unit