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Pediatrics > Kidney Injury > Flashcards

Kidney Injury Flashcards

1
Q

What is AKI?

A

1- decrease GFR
2- Elevated Creatinine
3- Decrease urine output

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2
Q

What are the anatomical types of AKI?

A
  • Pre-renal
  • renal
  • post-renal
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3
Q

What are the pre-renal causes of AKI?

A

decrease perfusion (hypovolumeia)

HF, Sepsis, Cirrhosis

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4
Q

What are the internsic causes of AKI?

A

Renal parynchymal injury

Prolonged hypoperfusion, sepsis, nephrotoxins, glomerular disease

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5
Q

What are the post-renal causes of AKI?

A

Anatomic obstruction of lower UTI

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6
Q

What is the RIFLE classification standfor acute kidney injury

A 
R: risk of renal dysfunction
I: injury to the kidney
F: failure of kidney function 
L: loss of kidney function 
E: End stage renal disease
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7
Q

What is the risk for renal dysfunction?

A

Creatinine clearance: <25%

Urine output: <0.5\kg for 8hr

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8
Q

What is the injury to the kidney?

A

Creatinine clearance: <50%

Urine output: <0.5\kg for 16hr

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9
Q

What is the failure of kidney to function?

A

Creatinine clearance: <75%
Urine output: <0.3\kg for 24hr

OR

Creatinine clearance: <35 ml per 1.73
Urine output: anuria for 12 hours

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10
Q

When to say there’s loss of kidney function?

A

Presistent failure >4weeks

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11
Q

When to say there’s end stage renal disease?

A

Presistant failure >3 months

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12
Q

What are the clinical symptoms for AKI?

A
  • edema
  • Hypertension
  • gross hramturia
  • reduce urine output
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13
Q

What other lab findings could be found in AKI?

A
  • hyperkalemia
  • hyperphosphatemia
  • Hypocalcemia
  • metabolic acidosis
  • serum sodium abn.
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14
Q

What suggest prerenal kidney diesase?

A
  • vomiting
  • diarrhea
  • low oral intake

(Low urine output)

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15
Q

What suggest hemolytic uremic syndrome?

A

Bloody diarrhea 3 to 7 days prior to the onset of oligourea

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16
Q

What suggest post-strep glomerulonephritis?

A

Pharyngitis - impetigo before hematuria or edema

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17
Q

What suggest intense nephrotoxicity

A

Hospitilized patient Recieving nephrotoxic medication

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18
Q

What suggest HSP or SLE

A

Fever, joint complaints, rash

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19
Q

What investigations to order in AKI?

A
  • urinalysis
  • CBC
  • sodium excretion
  • complement
  • Strep infection serology
  • aminoglycosides
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20
Q

To differentiate between pre and internsic AKI we can measure

A

Fractional sodium excretion

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21
Q

Elevated amingolgucoside indicate

A

Acute tubular necrosis

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22
Q

What to look for in physical exam of AKI? (In general)

A
  • edema And weight gain
  • BP
  • systemic: joint disease\rash
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23
Q

What suggest prerenal AKI (PA)

A
  • volume depletion (dry mucus, tachycardia, decreased BP)
24
Q

What suggest renal vein thrombosis AKI (PA)

A

Enlarged palpable kidney

25
Q

What suggest puretheral obstruction in AKI (PA)

A

Enlarged bladder.

26
Q

What is the role of kideny biopsy in AKI?

A

When diagnosis is not made clear and to guide treatment in acute glomerulonephritis

27
Q

Differentiate between AKI and ATN:

“Prerenal AKI, and Internsic AKI”

A

Prerenal: high specific gravity - >40 creatinine - <20 Na - <1% FENa - <35% FEUrea
(High SG, Creatinine - Low Na\urea)

Internsic: low specific gravity - <20 creatinine - >40 Na - >2% - >50%

28
Q

What is the general management approach for AKI?

A

1- specific tx for underlying
2- Fluid, electrolyte, Nutritional
3- drug dosing
4- renal replacement therapy

29
Q

Summarize fluid management of acute kidney injury

A
  • Hypovoluemic: NS bolus
  • Euvolemic: “ongoing insensible fluid loss” balanced w\ adminsterd fluids
  • Hypervolumic: fluid removal by furosamide
30
Q

What should you stop patient with olgourea\aneuria from taking

A

Potassium

Phosphorus

31
Q

What should you advice about sodium ingestion in AKI?

A

Restrict sodium intake to prevent fluid retention > HTN

32
Q

Whar is the most common\severe complication of AKI?

A

Hyperkalemia “cardiac arrythmia”

33
Q

How to treat metabolic acidosis in AKI?

A

Sodium bicarb (debatable)

34
Q

What should be the caloric intake in AKI?

A

It should increase to counterpart the catabolic needs of a patient
“120 kcal\Kg in infant - 150% of the maintance need in older children”

35
Q

What are the indication for renal replacement therapy?

A
  • uremia
  • hyperkalemia unresponsive
  • fluid overload unresponsive
36
Q

What is the prognosis of AKI

A

Increased mortality

In mod-severe, follow up to detect signs of CKD

37
Q

What is the CKD?

A

Structural\functional kidney damage presist over 3months

38
Q

What is the functional kidney damage?

A
  • decrease GFR
  • increased Proteinurea
  • both
39
Q

Define chronic kidney injury according to KDIGO

A
  • GFR<60 w\out CKD markers for 3 months

- GFR >60 w\structural - CKD markers (proteinurea, albuminurea, tubular disorders)

40
Q

What are the stages of chronic kidney disease according to the KDIGO?

A
  • G1: >90
  • G2: 60- 89
  • G3a: 45 - 59
  • G3b: 30 - 44
  • G4: 15 - 29
  • G5: <15
41
Q

Name the most common etiologies of CKD

A
  • conginital anomaly of the kidney (hypoplasia or dysplasia)
  • conginital anomaly of urinary tract (obstructive uropathy)
42
Q

What is the second largest cause of childhood CKD?

A

Glomerular disorders

“>12 years of age”

43
Q

How do children with non-glomerular disease usually present?

A
  • asymptoamtic
  • polyuria
  • poor growth
44
Q

What is the best way to diagnose children with non-glomerular CKD?

A

Imaging

And investigations for creatinine

45
Q

How does paatient with glomerular disease CKD usually present?

A

More prominant signs and symptoms

46
Q

How to detect CKD in early stages?

A

Usually they are asymptomatic

  • elevated serum creatinine
  • prenatal ultrasound for kidney disease.
47
Q

In which stage of CKD do we commonly see poor growth?

A

Stage 3 CKD

48
Q

In which stage do we commonly see uremia, weakness, fatigue, anorexia or vomitting

A

Stage 4 and 5

49
Q

What to obtain from the history of CKD

A
  • seizure
  • anemia
  • recurrent UTI
  • high BP
  • polyruia\polydipsia
  • poor growth
  • family hx of HTN\renal
  • orthopedic\urologic abnormalities
  • conginital anomaly of kidney
50
Q

What physical xamination to do in CKD

A

1- growth parameters (H, W, head circumference) + BP

2- Hyper-volemia (edema - rales - hepatic - cardiac gallop)

3- auscultation: pericardial rub (pericarditis) - diminished heart sound (pericardial effusion)

4- pallor in anemia

51
Q

What imaging can be used for evaluating CKD?

A
  • US: initial when suspecting CKD
  • VCUG: for [vesicouretric reflux]
    hydronephrosis - posterior uretheral valve
  • renal scan: focal abnormalities - obstruction
  • other CT & MRI
52
Q

What are the lab investigations for CKD?

A
  • serum creatinine
  • Serum bicarbonate
  • CBC
  • URinalysis
  • protein\creatinie ratio in urine

Additional

  • Calcium
  • phosphorus
  • 25 hydroxyvitamin D
  • PTH
53
Q

In obstructive uropathy and dysplastic kidney, what happens to salt excretion?

A

Increased leading to hypovoluemia

54
Q

How to trat ckd when theres anemia

A

Iron and if severe give erythrropoetin (till gb 11)

55
Q

How to treat ckd with hypertension?

A

Arb - ace

Pediatrics (41 decks)

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