Acute Kidney Injury In Children

Acute kidney injury is an abrupt decline in renal function causing impaired regulation of fluid, electrolytes and metabolic waste. Causes are classified as prerenal, intrinsic renal and postrenal.

KDIGO defines AKI by a rise in serum creatinine of at least 26.5 micromol/L within 48 hours, increase to at least 1.5 times baseline within 7 days, or reduced urine output.

• Oliguria or anuria
• Oedema
• Hypertension
• Vomiting
• Lethargy
• Fluid overload
• Features of the underlying illness

Life threatening complications include:

• Hyperkalaemia
• Pulmonary oedema
• Severe metabolic acidosis
• Uraemic encephalopathy

Assess:

• Serial creatinine
• Urine output in mL/kg/hour
• Electrolytes
• Bicarbonate
• Urinalysis
• Urine microscopy

Renal ultrasound is important when obstruction or structural disease is possible.

Determine volume status carefully.

• Treat the underlying cause.

• Restore circulating volume when genuinely hypovolaemic, but avoid repeated fluids in intrinsic renal failure or established overload.

• Stop nephrotoxic medications and adjust all renally cleared drugs.

• Strictly record fluid input, urine output and daily weight.

• Treat hyperkalaemia urgently when significant or associated with ECG changes.

• Dialysis is required for refractory hyperkalaemia, severe acidosis, pulmonary oedema or fluid overload resistant to medical treatment, significant uraemic complications or selected toxic exposures.