Neonatal Acute Kidney Injury-An Australian and New Zealand Perspective

Acute kidney injury (AKI) is increasingly recognized as a critical and underdiagnosed condition among neonates, with significant short and long-term implications for survival, kidney function, and long-term cardiovascular health. Neonatal physiology, including ongoing nephrogenesis, immature renal haemodynamics, and limited glomerular filtration, makes this population vulnerable to AKI. Advances in consensus definitions, particularly the modified neonatal Kidney Disease Improving Global Outcomes (KDIGO) criteria, have enhanced epidemiologic understanding and facilitated global research collaboration. Despite this, significant variability in AKI surveillance, diagnosis, and follow-up persists. Recent research efforts within Australia emphasize the need to incorporate AKI metrics into quality registries and improve equity of kidney care for infants. Integration of protocolized monitoring, preventative strategies such as nephrotoxin stewardship and methylxanthine therapy, and long-term follow-up for AKI survivors are essential to mitigating progression to chronic kidney disease. This narrative review synthesizes evolving evidence in neonatal renal physiology, AKI definition and biomarkers, epidemiology, management, and policy directions, emphasizing opportunities for education, protocol development, and collaborative improvement across Australia, New Zealand and beyond.