Whether the egg or the chicken came first remains debated, although the debate is not critical for those who love eating omelets. At least, it is well accepted that one needs to break eggs to fry an omelet. In some ways, there are similarities with acute kidney injury. A lot of debate arises from whether acute kidney injury is a complication of various insults and therapies or an expected continuum of the organ failure process. Indeed, it is well accepted that acute renal failure is associated with increased mortality in severely ill children and infants.