| Summary: | Acute kidney injury (AKI) is a common complication following cardiac surgery under cardiopulmonary bypass (CPB) in children. A prospective study for examining urinary neutrophil gelatinase-associated lipocalin (NGAL) and renal near-infrared spectroscopy (NIRS) trends during AKI was conducted among pediatric patients undergoing cardiac surgery with CPB. Urinary NGAL showed a significant difference between intensive care unit admission (0 h) and 2 h post-admission (<i>p</i> < 0.001) and remained significant up to 4 h (<i>p</i> < 0.05). The renal NIRS in the AKI group showed a significant rate of decrease and lower values during the intraoperative period (<i>p</i> < 0.05). The cumulative median saturation of renal regional saturation of oxygen (rSO<sub>2</sub>) during CPB was 1637.5% min in the AKI group and 943.0% min in the non-AKI group. The median renal rSO<sub>2</sub> scores at a reduction of 20% and 25% were significantly higher (<i>p</i> < 0.001) in the AKI group. Our results suggest that monitoring renal rSO<sub>2</sub> scores and limiting their decline might be useful in preventing AKI. The combination of NGAL, renal rSO<sub>2</sub>, and renal rSO<sub>2</sub> scores might be useful in the early diagnosis of AKI during pediatric cardiac surgery.
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