AKI

Answer 1

Oliguria
Urine output < 300 ml/m2/day
< 0.5ml/Kg/hr(in children) <400–500ml/day(in children) < 1.0ml/Kg/hr (in infants)
Anuria : < 1 ml/Kg/day

Question 2

MC AKI

Answer 2

Prerenal causes hypovolemia

Question 3

Post-renal failure

Answer 3

Post-renal failure
Obstruction
PUV
Neurogenic bladder
Calculi, etc.

Answer 4

Hyponatremia is a common finding in children with ARF is most frequently secondary to water excess rather than Na+ loss

Question 5

Hyperkalemia

Answer 5

Hyperkalemia :
Calcium gluconate 0.5-1 ml/kg over 5 to 10 minute Salbutamol nebulization Glucose 0.5-1 gm/kg with 0.1-0.2 unit/kg insulin Sodium bicarbonate 1-2 ml/kg

Question 6

CKD

Answer 6

Irreversible loss of renal function with resultant decrease in GFR

Question 7

RF/ESRD

Answer 7

<15GFR

Question 8

MC of CKF

Answer 8

Cong. abnormalities
Obstructive uropathy
Reflux nephropathy

Question 9

Features suggestive of CKD

Answer 9

Features suggestive of CKD
• Family Hx. of renal dis. • Small kidneys, cystic, abn. collecting systems,
ureters and urinary bladder on us • Normochronic, normocytic anemia
• End organ effects of HTN
e.g. retinopathy
• Poor growth • Radiological evidence of rickets
(Renal osteodystrophy)

Question 10

Investigation to assess the severity and duration of CKD

Answer 10

CBC • Biochem.
Na, K, Urea, Creatinine, Ca, PO4, Alk. ph. Total protein, albumin, urate Blood pH, HCO3 PTH Urine : Cr., PO4, albumin
• GFR • Wrist X-ray • CXR • ECG or Echo

Question 11

Restriction of PO4 intake • PO4 binders:

Answer 11

↓PO4 level → ↑endogenous 1,25(OH)D and

ICa+ → normalize PTH levels

Question 12

Vit. D supplement
A dynamic bone dis. with high dose of 1,25(OH)D –
antiproloferative effect on osteoblasts

Answer 12

Check
Plasma Ca, PO4, AP } Each visit
PTH level
X-ray left hand and wrist } Yearly

Question 13

Preservation of renal function

CKD

Answer 13

Preservation of renal function
• Control of HTN • Reduction of proteinuria • ACE inhibitor – renoprotective independent of
their effect on BP in both diabetic and non-
diabetic nephropathies
Taal MW, Brenner BM. Kidney Int. 2000; 57: 1803-1817.

Question 14

Growth

Answer 14

Most sensitive indicator of adequacy of CRF
treatment • Factors to growth retardation:
Renal osteodystrophy
Inadequate energy intake Inappropriate protein intake Disturbance of water & electrolyte
balance esp. NaCl and metab. Acidosis

Hypertension • Infection • Anemia • Hormonal abn. • Corticosteroid therapy • Psychosocial factors