acute kidney injury

v.djabatey
Mind Map by , created over 5 years ago

Paediatrics (kidneys ) Mind Map on acute kidney injury, created by v.djabatey on 01/30/2014.

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Created by v.djabatey over 5 years ago
spectrum of renal disease in kids
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renal tubular disorders
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renal masses
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Key Biology Definitions/Terms
mia.rigby
GCSE AQA Physics - Unit 1
James Jolliffe
Renal System A&P
Kirsty Jayne Buckley
The Kidneys (Nephron)
mtgbowen
Acid-Base Balance
sophietevans
congenital abnormalities
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Assessment of kidneys & urinary tract
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acute kidney injury
1 @ severe end of spectrum is acute renal failure
1.1 sudden, potentially reversible, reduction in renal function
2 oliguria (0.5 ml/kg per hour) usually present
3 classification
3.1 prerenal
3.1.1 commonest cause in kids
3.1.2 hypovolaemia
3.1.2.1 gastroenteritis
3.1.2.2 burns
3.1.2.3 sepsis
3.1.2.4 haemorrhage
3.1.2.5 nephrotic syn
3.1.3 circulatory failure
3.2 renal
3.2.1 salt & water restriction; blood, protein & casts present in urine & perhaps sx specific to accompnying disease
3.2.2 vascular
3.2.2.1 haemolytic uraemic syn (HUS)
3.2.2.1.1 triad
3.2.2.1.1.1 acute renal failure
3.2.2.1.1.2 microangiopathic haemolytic
3.2.2.1.1.3 thrombocytopenia
3.2.2.1.2 typically 2ndary to GI infection
3.2.2.1.2.1 E. coli O157:H7
3.2.2.1.2.1.1 makes verocytotoxin
3.2.2.1.2.1.2 acquired by
3.2.2.1.2.1.2.1 eating uncooked beef
3.2.2.1.2.1.2.2 contact w/ farm animal
3.2.2.1.2.1.3 commonly
3.2.2.1.2.2 Shigella
3.2.2.1.3 follow prodrome of bloody diarrhoea
3.2.2.1.4 toxin from pathogen enter GI mucosa
3.2.2.1.4.1 then localises to renal endothelial cells & cause intravasc thrombogenesis
3.2.2.1.4.1.1 coagulation cascade activated & clotting normal
3.2.2.1.4.1.1.1 platelets consumed
3.2.2.1.4.1.1.2 microangiopathic haemolytic anaemia results
3.2.2.1.4.1.1.2.1 due to damage to RBC as they go through microcirculation
3.2.2.1.5 brain, heart, pancreas may also be involved
3.2.2.1.6 atypical HUS
3.2.2.1.6.1 no diarrhoeal prodrome
3.2.2.1.6.2 may be familial
3.2.2.1.6.3 often relapses
3.2.2.1.6.4 high risk of HTN & chronic renal failure
3.2.2.1.6.5 high mortality
3.2.2.1.7 Mx
3.2.2.1.7.1 typical HUS (diarrhoea-assoc)
3.2.2.1.7.1.1 supportive therapy
3.2.2.1.7.1.2 dialysis
3.2.2.1.7.1.3 follow up
3.2.2.1.7.1.3.1 may be persistent proteinuria
3.2.2.1.7.1.3.2 development of HTN
3.2.2.1.7.2 atypical HUS or cerebral involvement
3.2.2.1.7.2.1 plasma exchange/infusions
3.2.2.1.7.2.1.1 unproven efficacy
3.2.2.2 vasculitis
3.2.2.3 embolus
3.2.2.4 renal vein thrombosis
3.2.3 tubular
3.2.3.1 acute tubular necrosis (ATN)
3.2.3.2 ischaemic
3.2.3.3 obstructive
3.2.4 glomerular
3.2.4.1 glomerulonephritis
3.2.5 interstitial
3.2.5.1 interstitial nephritis
3.2.5.2 pyelonephritis
3.3 postrenal
3.3.1 from urinary obstruction
3.3.1.1 congenital e.g post urethral valves
3.3.1.2 acquired e.g. blocked urinary catheter
4 acute renal failure suggested by
4.1 growth failure
4.2 anaemia
4.3 renal osteodystrophy
4.3.1 disordered bone mineralisation
5 Mx
5.1 meticulous monitoring
5.1.1 circulation
5.1.2 fluid balance
5.2 Ix
5.2.1 US
5.2.1.1 to ID obstruction of urinary tract
5.2.1.2 small kidneys of chronic renal failure
5.2.1.3 large bright kidneys w/ loss of cortical medullary differentiation
5.2.1.3.1 typical of acute process
5.3 prerenal ARF
5.3.1 suggested by hypovolaemia
5.3.1.1 fractional excretion of Na+ very low as body tries to retain fluid
5.3.1.2 hypovol needs urgent correction to avoid acute renal tubular necrosis
5.3.1.2.1 fluid replacement
5.3.1.2.2 circulatory support
5.4 renal ARF
5.4.1 if circulatory overload present to correct Na+ & water balance, gradually
5.4.1.1 restrict fluid intake
5.4.1.2 diuretic
5.4.2 high calorie, normal protein feed
5.4.2.1 decreases catabolism, uraemia & hyperkalaemia
5.4.3 emergency mx of metabolic abnormalities
5.4.3.1 metabolic acidosis
5.4.3.1.1 sodium bicarbonate
5.4.3.2 hyperphosphataemia
5.4.3.2.1 calcium carbonate
5.4.3.2.2 dietary restriction
5.4.3.3 hyperkalaemia
5.4.3.3.1 calcium gluconate if ECG changes
5.4.3.3.2 calcium exchange resin
5.4.3.3.3 glucose & insulin
5.4.3.3.4 dietary restriction
5.4.3.3.5 dialysis
5.4.4 if cause of renal failure not obv
5.4.4.1 renal biopsy
5.4.4.1.1 to ID rapidly progressive glomerulonephritis
5.4.4.1.1.1 may need immediate immunosuppresion
5.4.5 commonest causes of ARN in kids in UK
5.4.5.1 haemolytic uraemic syn
5.4.5.2 acute tubular necrosis
5.4.5.2.1 multisys failure in ICU
5.4.5.2.2 ff cardiac surgery
5.5 postrenal ARF
5.5.1 needs assessment of site of obstruction
5.5.2 relief of obstruction
5.5.2.1 nephrostomy
5.5.2.2 bladder catheterisation
5.5.3 surgery can be done once fluid vol & electrolyte abnormalities corrected
5.6 dialysis
5.6.1 indications
5.6.1.1 failure of conservative mx
5.6.1.2 hyperkalaemia
5.6.1.3 severe hypo or hypernatraemia
5.6.1.4 pul oedema or HTN
5.6.1.5 severe acidosis
5.6.1.6 multisys failure
5.6.2 peritoneal
5.6.3 haemodialysis
5.6.3.1 used if plasma exchange part of Rx
5.6.3.2 continuous arteriovenous or venovenous
5.6.3.2.1 if cardiac decompenation or hypercatabolism
6 generally good prognosis for renal recover unless complicating a life-threatening condition

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