Acute Kidney Injury in Pediatrics

Acute term in medicine means some symptom that has developed over a short time(days to weeks) and has led to disturbed functioning in the body. By reading this blog, you will be able to define AKI, know the clinical features and some pathognomic signs related to acute kidney injury (AKI), and enumerate various treatment options.

Definition of Acute Kidney injury 

When there is a sudden loss of kidney function that is there could be very low urine output or excessive urine output, which is manifested in any of the three ways:

Increase in serum creatinine by ≥0.3 mg/dl from baseline within 48 hours 

or 

Increase in serum creatinine by ≥ 50% within prior 7 days 

or

Urine volume ≤ 0.5ml/kg/hr from ≥ 6 hrs

To understand Acute kidney injury and improve the overall outcome, a staging was developed by KDIGO known as the KDIGO staging for acute renal injury. This global nonprofit organization develops and implements evidence-based clinical practice guidelines for kidney disease. The classification is as follows:

This Acute kidney injury topic has many important values that must be memorized. These can help solve MCQs for any competitive medical exam.

Acute kidney injury is a relatively progressive disease that can be fatal as well, especially in the pediatric age group. Hence, it becomes very important to classify the disease for easy understanding of the symptoms and timely resolution. It is very helpful when any text is written in a comparable form, such as a table. All the points can be read at a glance. AKI can be classified as:

Diagnosis of Acute Kidney Injury 

Certain symptoms of acute kidney injury in a patient show the development of the disease over time, such as decreased urine output with or without edema, encephalopathy, and arrhythmias. A few lab parameters are used to correctly divide between pre-renal Acute kidney injury and renal Acute kidney injury.

Acute kidney injury has a few complications that arise when the disease is not treated properly due to the physician's mistake or when the patient is non-compliant. These complications can have their due course or can add to the existing symptoms. They can also change the course of the disease from acute to chronic. The main complication:

1. Metabolic Complications: These can be in the form of hyperkalemia, Hypocalcemia, Hyponatremia, and Hyperphosphatemia. Hyperkalemia can be seen in the form of arrhythmias.
2. Cardiopulmonary Complications: Pulmonary edema, Heart failure, Severe hypertension
3. Hematologic Complications: Anemia and Bleeding
4. Neurologic: Irritability, Seizure and Encephalopathy 

Acute kidney injury can have dreadful complications, and hence, it is very important to treat this effectively and urgently.

Treatment of Acute Kidney injury 

• First and foremost, urine output needs to be monitored, and for that, we need to catheterize the bladder.
• If any urinary obstruction is present, it needs to be relieved.
• If there is no fluid overload (or Heart failure), then a fluid challenge needs to be done with normal saline 20ml/kg over 30 minutes.
• Diuretics are considered after ensuring the adequacy of the circulating blood volume. If there is no response to diuretics, they need to be stopped.
• For patients with normal intravascular volume, fluid is given every 24 hours, known as the AKI regime.
• In case of Insensible loss of fluids, replace urine output volume by volume (400ml/m²/24 hrs) 
• Nephrotoxic drugs need to be avoided & stopped. If stopping is not possible, then their dosage will be modified. 

Certain complications also need to be attended to, and treatment should be initiated.

There is another treatment option in the case of AKI known as Renal Replacement Therapy (RRT), which has certain indications like

• Volume overload with pulmonary Edema
• Refractory Hyperkalemia
• Severe refractory Metabolic acidosis 
• Uremic encephalopathy/pericarditis

The various modalities of RRT are:

• Intermittent Hemodialysis: these can only be used for Hemodynamically stable patients. 
• Peritoneal Dialysis: In neonates and infants, peritoneal dialysis is an option to remove excess fluid, correct electrolyte problems, and remove toxins.
• Continuous Renal Replacement Therapy (CRRT): Preferred in Hemodynamically unstable critically ill patients in ICU setting.

Also Read: Bed Wetting: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

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