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Over the past two decades, the etiology and therapy of acute kidney injury (AKI) in children has changed. Historically, hemolytic uremic syndrome was the major cause of pediatric AKI, but advances in technology have meant that sepsis and deterioration of often unrecognized long-term organ dysfunction are now more common causes of pediatric AKI in the developed world. At the same time, major advances in renal replacement therapy in children have occurred as a result of improved strategies for vascular access, more-adaptable equipment, and better techniques and protocols. This Review outlines the etiology, incidence, diagnosis, and treatment-both dialytic and non-dialytic-of pediatric AKI.