ACUTE KIDNEY

INJURY
-DR.SRI LAXMI
DR-HINDUJA
MODERATED BY DR CHANDINI
 DEFINITION
• Abrupt (2 to 7 days) and sustained decline in GFR and an
inability of kidneys to appropriately regulate regulate
fluid,electrolytes, and acid base homeostasis
p-RIFLE
PATHOGENESIS
PHASES OF AKI
COMMON CAUSES
 HISTORY
• 3 DAY HISTORY OF VOMITING,DIARRHEA
• PHARYNGITIS WITH PERIORBITAL
EDEMA,HYPERTENSION,HEMATURIA
• CRITICALLY ILL CHILD WITH PROTRACTED
HYPOTENSION AND EXPOSURE TO NEPHROTOXIC
DRUGS
• NEONATE WITH H/0 HYDRONEPHROSIS ON SCAN AND
PALPABLE BLADDER
 CLINICAL FEATURES
PRE-RENAL RENAL POST RENAL
TACHYCARDIA HTN PALPABLE FLANK MASS
DRY MUCOUS PERIPHERAL EDEMA
MEMBRANES
POOR PERIPHERAL RALES
PULSES
CARDIAC GALLOP
RASH
ARTHRITIS
 LABORATORY
• Hemoglobin
• TLC
• Platelet
• S.electrolytes
• ABG
• RFT
 URINE
• GLOMERULAR –hematuria,proteinuria,RBC, granular
casts
• TUBULO INTERSTITIAL- WBC,WBC casts, low grade
hematura, proteinuria
• DRUG INDUCED- eosinophils
URINARY INDICES
 RADIOLOGY
• CXR- cardiomegaly,pulmonary congestion,pleural effusion
• USG –hydronephrosis,hydroureter,nephromegaly
 OTHER MARKERS
• NGAL- Neutrophil Gelatinase Associated Lipocalcin
• TIMP-2- Tissue Inhibitor Mettaloproteinase-2
• IGFBP7- Insulin like Growth Factor Binding Protein 7
 MEDICAL MANAGEMENT
• Bladder catheterization
• IVF-NS 20 ml / kg in 30 min if no evidence of fluid
overload

• Hypovolemic patients generally void within 2 hours

 DIURETICS
• Should be administered after assessing adequacy of
circulating blood volume
• FUROSEMIDE-2 – 4 mg/kg single IV dose
• MANNITOL- 0.5 gm/kg single IV dose
• BUMETANIDE-0.1 mg/kg
• If UOP not improving consider diuretic infusion
 HYPERKALEMIA
>6 MEQ/LIT >7 MEQ/LIT
LIMIT EXOGENOUS SOURCES 10% CA GLUCONATE 1 ML/KG OVER
5 MIN
KAYEXALATE 1GM/KG EVERY 2 BICARBONATE-1-2 MEQ/KG OVER 5
HOURS TO 10 MIN
REGULAR INSULIN 0.1 U/KG WITH
GLUCOSE 50%SOLUTION 1ML/KG
OVER 1 HOUR
 METABOLIC ACIDOSIS
• Rarely requires correction
• Correction required if pH <7.15 HCO3 <8 MEQ/L
 HYPOCALCEMIA
• Primarily treated by lowering serum phosphorous
• Avoid IV route except in cases of tetany
• Low phosphorous diet
 HYPONATREMIA
• Mostly dilutional
• Corrected by fluid restriction
• Indications of 3% saline-symptomatic hyponatremia
-S.sodium <120 meq/l
 GI BLEED
• Due to uremic platelet dysfunction,stress,heparin
exposure in hemodialysis
• Oral or iv ranitidine
 HYPERTENSION
• Common in ARF patients with AGN or HUS
• Salt and water restriction, diuretics
• ISRAPIDINE – 0.05MG/KG/DOSE
AMLODIPINE-0.1 TO O.6 MG/KG/DAY QID OR BD
PROPRANOLOL-0.5 TO 8 MG/KG/DAY BD OR TID
LABETALOL-4 TO 40 MG/KG/DAY BD OR TID
• Severe symptomatic HTN-continuous sod.nitroprusside infusion
 NEUROLOGIC SYMPTOMS
• Headache,seizures,lethargy,confusion
• DIAZEPAM
 ANEMIA
• PRBC transfusion if Hb<7gm/dl
• Slow transfusion over 4 to 6 hours 10ml/kg
 NUTRITION
• Restrict sodium,potassium,phosphorous
• PROTEIN- restricted CALORIE- maximised to minimize
accumularion of nitrogenous waste
 DIALYSIS-INDICATIONS
• Volume overlod with evidence of HTN/pulmonary edema
refractory to diuretic therapy
• Persistent hyperkalemia
• Sever metabolic acidosis unresponsive to medical management
• Neurological symptoms
• BUN>100 TO 150 MG/DL
• Calcium/phosphorous imbalance with hypocalcemic tetany
 PROGNOSIS
• Low mortality in PSGN
• High mortality in multiorgan failure
• REFERENCES-NELSON TEXTBOOK OF
PEDIATRICS(20TH)

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