Dr. Rafia Gul
Neonatologist & Pediatrician
Neonatal KDIGO 2026 AKI staging and Schwartz eGFR compared with expected GFR for postmenstrual age. For healthcare professionals.
Stage = the worst of the creatinine (C) and urine output (U) criteria. Baseline SCr is the lowest previous value; ratio criteria apply within 7 days, an absolute rise ≥0.3 mg/dL within 48 h. In the first days of life SCr partly reflects maternal values, so use trends, not a single value.
AKI is present with any one of: no decline in SCr from birth to day 7; SCr rise ≥0.3 mg/dL (26.5 µmol/L) within 48 h; SCr ≥1.5× baseline within 7 days; cystatin C ≥1.25× baseline within 7 days; cystatin C >2.2; urine output <1.0 mL/kg/h for ≥24 h.
| Stage | Serum creatinine | Urine output (24 h) |
|---|---|---|
| 1 | C1: no decline in SCr from birth to day 7, or rise ≥0.3 mg/dL, or 1.5–1.9× baseline | U1: >0.5 and ≤1.0 mL/kg/h |
| 2 | C2: 2.0–2.9× baseline | U2: >0.3 and ≤0.5 mL/kg/h |
| 3 | C3: ≥3× baseline, or SCr ≥2.5 mg/dL (220 µmol/L), or RRT | U3: ≤0.3 mL/kg/h |
Source: KDIGO 2026 Clinical Practice Guideline for AKI and AKD, public review draft (March 2026), §1.6.3–1.6.4, Tables 12–13; it updates KDIGO 2012 (Kidney Int Suppl 2012;2:1–138). This is the draft version, so check the final publication for any changes. The draft stages neonatal AKI by SCr and urine output only. Cystatin C counts for diagnosis, not staging; if it is the only criterion met, this page shows AKI without a stage and treats it as stage 1 for the guidance below. The draft prints the cystatin C cut-off of 2.2 as mg/dl, and this page uses mg/L.
Uses the current SCr from Part 1.
Sources: expected GFR = Rhodin et al., Pediatr Nephrol 2009;24:67–76 (pooled measured GFR, 22 wk PMA to adult; PMA fits better than postnatal age alone). Preterm range = Vieux et al., Pediatrics 2010;125:e1186 (27–31 wk GA, measured creatinine clearance). Schwartz k values: 0.33 (LBW <1 yr), 0.45 (term <1 yr) per FDA 2014 pediatric guidance; Brion et al., J Pediatr 1986;109:698. The % cut-offs for “reduced” are a working convention, not validated thresholds.