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Acute Kidney Injury in Pediatric Patients: Diagnosis and Management in the Emergency Department

May 2017

Inside This Issue

Not only can a missed diagnosis of pediatric acute kidney injury (pAKI) lead to a lifetime of chronic kidney disease (CKD) and increased mortality, but the entity is also often underdiagnosed in the ED. Unfortunately, reasons for diagnostic confusion are legion, starting with lack of sensitive and specific biomarkers for identifying kidney injury at an early stage and zero clinical agreement on a definitive classification system for AKI.  While elevated serum creatinine (SCr) can give clinicians reasonably certain indications of pAKI, an increase in SCr can be delayed after injury, and without known baselines, early diagnosis can be problematic.  In addition, normal SCr levels vary widely in children, and levels that appear low often provide a deceptive indication that pAKI has not occurred. Even once a definitive diagnosis of  AKI is made, patients remain at risk for CKD, and consultation with a nephrologist is often indicated. This article helps clinicians make sense of the three current classification systems for pAKI and sort through its many disparate causes, as well as providing clear clinical pathways and practical solutions to pAKI's most common risk management pitfalls.

Keywords: acute kidney injury, AKI, pediatric acute kidney injury, pAKI, chronic kidney disease, acute renal failure, RIFLE, pRIFLE, Acute Kidney Injury Network, AKIN, Kidney Disease Improving Global Outcomes, KDIGO, nephrotoxin, nephrotoxic agent, contrast-induced nephropathy, hemolytic uremic syndrome, rhabdomyolysis, poststreptococcal acute glomerulonephritis, PSAGN, renal vein thrombosis, serum creatinine, SCr, estimated creatinine clearance, eCCl, renal replacement therapy, emergency room, emergency department, acute kidney injury in children, glomerular filtration rate, ARF

Points

  • Patients who receive one or more nephrotoxic agents are significantly more likely to develop AKI. Nephrotoxin-induced AKI may not be associated with oliguria, making urine output a less sensitive diagnostic tool for AKI.
  • NSAIDs can lead to AKI, even with short-term treatment, particularly in the setting of hypovolemia or pre-existing kidney injury.

Pearl

  • Pediatric AKI was previously thought to be transient and reversible; however, it is now known that it can cause permanent damage. Early diagnosis and proper treatment can mitigate potential long-term effects.
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Last Modified: 08/16/2017
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