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