Acute kidney injury (AKI) is a commonly encountered comorbidity in critically ill children. The coexistence of AKI disturbs drug pharmacokinetics and pharmacodynamics, leading to clinically significant consequences. This can complicate an already critical clinical scenario by causing potential underdosing or overdosing giving way to possible therapeutic failures and adverse reactions. Current available studies offer little guidance to help maneuver such complex dosing regimens and decision-making in pediatric patients as most of them are done on heterogeneous groups of adult populations. Though there are some studies on drug dosing during continuous renal replacement therapy (CRRT), their utility is in question because of the recent advances in CRRT technology. Our review aims to discuss the principles of pharmacokinetics pertinent for honing the existing practices of drug dosing in critically ill children with AKI, and the various complexities and intricate challenges involved. This in turn will provide a framework to help enable caretakers to tailor dosing regimens in complex clinical setups with further ease and precision.

急性肾损伤（AKI）是危重儿童常见的合并症。AKI 的共存会扰乱药物药代动力学和药效学，导致临床上严重的后果。这可能会导致潜在的剂量不足或过量，从而导致可能的治疗失败和不良反应，从而使本已危急的临床情况变得复杂化。目前现有的研究几乎没有提供任何指导来帮助儿科患者实施如此复杂的给药方案和决策，因为大多数研究都是针对不同的成人群体进行的。尽管有一些关于连续肾脏替代治疗 (CRRT) 期间药物剂量的研究，但由于 CRRT 技术的最新进展，其效用受到质疑。我们的综述旨在讨论与改进 AKI 危重儿童药物剂量现有实践相关的药代动力学原理，以及所涉及的各种复杂性和复杂挑战。这反过来将提供一个框架，帮助护理人员在复杂的临床设置中更加轻松和精确地定制给药方案。