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Copy of AKI
Transcript of Copy of AKI
Pre-renal (Prerenal azotemia)
Hypoperfusion, which if sustained may lead to intrinsic disease
Must be bilateral to cause AKI
14yF with history of rapidly progressive MPGN and ESRD s/p orthotopic kidney transplant in 2009 presents with acute on chronic kidney failure.
How do we Know
Only helpful in adolescents and older children because of lower Cr levels in younger children
(More urea reabsorbed with H2O)
, VCUG, IVP, Mag 3, DMSA-pyelo
Not enough in
Abrupt, life-threatening reduciton of urinary output to <300mL/m2/day
((Sodium urinary × Flow rate urinary) ÷/ (Sodium plasma) )/ ((Creatinine urinary × Flow rate urinary) ÷ /(Creatinine plasma) )× 100
((Sodium urinary × Flow rate urinary)x (Creatinine plasma) x 100 ))/
(Sodium plasma) (Creatinine urinary × Flow rate urinary)
Standard to "characterize the pattern of acute kidney injury in critically ill children"
Renal vein thrombosis
Acute interstitial nephritis
Tumor lysis syndrome
Posterior urethral valves
Ureteropelvic junction obstruction
Ureterovesicular junction obstruction
Not as easy as bolus or restrict fluid
Lytes-K, Ca, Na
Acidosis-Does not usually require bicarb
Nutrition-most cases, sodium, potassium, and phosphorus should be restricted. Protein intake should be restricted
Seizures/encephalopathy-Diazepam effective, treat underlying cause
Prognosis-depends on underlying disease
RIFLE focuses on GFR, can also categorize severity by rise in serum creatinine: stage 1 >150%, stage II >200%, stage III >300%
14yF with history of membranoproliferative glomerulonephritis and renal transplant in 2009, presentes with elevated creatinine. Baseline Cr is 1.1, patient had scheduled lab draw today and her Cr was 2.5. The level had been trending up since last visit with Dr. Garro in May 2013. No Fever, diarrhea, vomiting, or abdominal pain. Endorses compliance with medications, with no recent changes.
PMH: Steroid induced DM, HTN, Cardiomyopathy, hyperlipidemia, anemia, Guillan-Barre, recurrent UTIs.
SH: Renal transplant 2009, multiple Bx
FH: No history of renal disease
Social: Finished 9th grade, denies alcohol, tobacco, drugs.
Meds: Furosemide, tacrolimus, prednisone, magnesium oxide, TMP/SMX, ASA, Amlodipine, lisinopril, Iron, Mycophenolate, acyclovir, docusate, fluxonazole, Glargine, Nitrofurantoin, sodium Bicarb, Icosapent, Reno Caps.
ROS: Positive for swelling of LE, Steroid induced DM, immunosuppression
T 37.4 P
RR 20 Sat 100% BP 117/78 Wt 44kg 10-25%
Gen: Awake, alert, NAD. Skin: Warm, well perfused
Heent: NCAT, MMM, OP clear, clear conjuctivae
CV: normal s1, s2,
soft SEM LLSB
, CR <2 seconds, 2+ pulses
Resp: Good air entry B, no crackles or wheezes, Nml WOB
GI: +BS, soft, ND/NT,
kidney palpated in RLQ
GU: SMR 3, normal external genitalia
1+ pitting edema LE
Psych: mom at bedside
Neuro: CN II-XII grossly intact, fluent speech, normal gait
Neck: FROM, no LAD Hem: no bleeding/bruising