Nephrotoxic Acute Kidney Injury (NAKI) Clinical Pathway

Children’s Hospital Colorado’s Nephrotoxic Acute Kidney Injury (NAKI) Pathway is designed to identify, monitor, and manage pediatric inpatients at risk of acute kidney injury (AKI) due to nephrotoxic medications. It also provides clinical guidance on obtaining urine neutrophil gelatinase-associated lipocalin (uNGAL) when serum creatinine is unavailable for AKI monitoring. The pathway incorporates evidence-based strategies to help reduce the incidence and severity of nephrotoxic AKI, ensuring safer, more effective patient care.

Access the Nephrotoxic Acute Kidney Injury clinical pathway:

• Nephrotoxic Acute Kidney Injury clinical pathway

About our Nephrotoxic Acute Kidney Injury (NAKI) clinical pathway

• This pathway expands on the Nephrotoxic Injury Negated by Just-in-Time Action (NINJA) program, a national initiative aimed at reducing nephrotoxic medication-related kidney injury.
• Developed by a multidisciplinary team of specialists including Critical Care, Hospital Medicine, Neonatology, Nephrology, Oncology, Pharmacy, and Surgery, using published literature and expert consensus.
• Nephrotoxic medications—such as aminoglycosides, vancomycin, IV contrast, and chemotherapy agents—can impair kidney function, leading to AKI. Early detection and proactive monitoring are essential for mitigating risk and ensuring appropriate supportive care.
• This pathway provides standardized protocols for:
• Early identification of AKI in at-risk patients.
• Routine monitoring of serum creatinine, uNGAL, urine output, and nephrotoxic exposure.
• Timely intervention to prevent kidney damage.
• Patient and caregiver education to support kidney health.
• By increasing awareness, streamlining implementation, and promoting adherence to evidence-based prevention strategies, this pathway helps optimize patient outcomes at Children’s Hospital Colorado.