AKI & CKD Flashcards
What are the criteria of AKI?
Anuria/Oliguria
HTN + Fluid overload
Rapid rise in Creatinine
How do you diagnose AKI?
Serum creatinine atleast 1.5x age specific reference creatinine (or previous baseline)
And UO <0.5ml/Kg for >8hrs
How do you classify AKI?
1-3
AKI 1 = Creatinine 1.5 ULRI (upper limit reference interval)
AKI 2 = 2-3x
AKI 3 = 3x
What can you do to prevent/reduce AKI?
- Maintain good hydration
- Minimise drugs
- Monitor UO, PEWS, BP & WEight
What are the major causes of AKI in kids?
- Pre-renal Hypoperfusion e.g. volume depletion or hypotension
- Intrinsic e.g. HUS, ATN or interstitial nephritis (NSAIDs, autoimmune)
- Obstructive
What organisms lead to HUS?
Enterohaemorrhagic E.coli (O157:H7)
Shigella
Due to toxins
What are the features of HUS?
Triad of:
- Haemolytic Anaemia
- Thrombocytopenia
- AKI
How do you manage HUS to prevent AKI?
3Ms:
- Monitor Fluid balance, U&Es, blood gas & BP
- Maintain IV saline & RRT
- Minimise = No Abx
Long term management following AKI?
BP & Proteinuria monitoring
Watching out for progression to cKD
What causes CKD?
55% CAKUT (oft with systemic syndromes e.g. turner’s or Trisomy 21)
17% hereditary e.g. cystic kidney disease
10% glomerulonephritis
How do we grade CKD?
G1-5 based on eGFR: 1 = normal 90+ml/min/1.73m^2 2 = 60-89 3 = 30-59 4 = 15-29 5 = ESRD
Kids with CKD will tend to be due to reflux nephropathy from CAKUT e.g. VUR. How is this likely to present?
Lots of UTIs from VUR
How could UTIs present in kids and neonates?
Neonates - Fever, vomiting, lethargy & irritability
Children:
- Fever
- Abdo/loing pain
- Vomiting
- Poor feeding
- Lethargy
- Irritability
- Dysfunctional Voiding
How can you diagnose a UTI?
Clean catch urine or midstream urine sample (if very sick catheter sample or suprapubic aspiration)
Dipstix for leucocytes & nitrites
Microscopy for pyuria & bacteria
Culture
What organisms cause most UTIs in kids?
85% are E.Coli
How do we grade Vesicoureteric Reflux?
1-5 and Unilateral vs bilateral
Which kids with UTIs would get imaging?
Upper tract symptoms (systemically unwell, high temp etc)
<6months old
Recurrent
How do we image in UTIs?
US for structure
DMSA - Scarring
Micturating Cystourethrogram - VUR
MAG 3 - Only works in older kids who are continent
How are childhood UTIs treated?
Lower Tract = 3 days oral Abx (trimethoprim or Co-amoxiclav)
Upper tract = 7-10days Abx (Oral if well or IV if systemically unwell)
How can we prevent further UTIs?
Hydration
Hygiene
Treat constipation
Image for abnormal Urinary tract
What do we monitor in kids with recurrent UTIs in case of CKD?
- HTN (Doppler is gold standard test)
- Proteinuria
What is HTN in a kid?
> 95th percentile
>90th is borderline
What do we need to manage in CKD?
- High urea
- Fluid balance
- Salt & Electrolytes
- Acid-base balance
- BP
- Erythpoietin deficiency
- Bone health
How do we treat high urea in CKD?
Control protein intake with nutrition
How do we handle the water balance in CKD?
REstrict or give fluids as needed
How do we handle electrolyte imbalance in CKD?
REstrict Salt intake
Give K
How do we handle acid base balance in CKD? (and what’s the abnormalitiy)?
You get Metabolic Acidosis in CKD due to bicarbonate loss
So give bicarbonate
How do we control BP in CKD?
ACEI
How do we handle the RBC effects of CKD?
Give Erythropoietin
How is bone health damaged by CKD?
Can’t excrete phosphate
- > High phosphate
- > High PTH
- > Metabolic bone disease & CVD
How do we manage bone health in CKD?
Low phosphate diet
Phosphate binder
Active Vit D
Growth hormone if ongoing poor growth
Important to watch out for hypercalcaemia with these treatments
Summary of management of CKD:
1) Control protein intake (urea)
2) Give/restrict fluids (water balance)
3) Restrict Na & Give K (Electrolyte balance)
4) Give bicarbonate (Acidosis)
5) ACEI (BP)
6) Erythropoietin
7) Low phosphate diet, phosphate binders & Active Vit D (bone health)
