acute kidney injury

Mind Map by , created over 5 years ago

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

Created by v.djabatey over 5 years ago
spectrum of renal disease in kids
renal tubular disorders
renal masses
Key Biology Definitions/Terms
GCSE AQA Physics - Unit 1
James Jolliffe
Renal System A&P
Kirsty Jayne Buckley
The Kidneys (Nephron)
Acid-Base Balance
congenital abnormalities
Assessment of kidneys & urinary tract
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 gastroenteritis burns sepsis haemorrhage 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 haemolytic uraemic syn (HUS) triad acute renal failure microangiopathic haemolytic thrombocytopenia typically 2ndary to GI infection E. coli O157:H7 makes verocytotoxin acquired by eating uncooked beef contact w/ farm animal commonly Shigella follow prodrome of bloody diarrhoea toxin from pathogen enter GI mucosa then localises to renal endothelial cells & cause intravasc thrombogenesis coagulation cascade activated & clotting normal platelets consumed microangiopathic haemolytic anaemia results due to damage to RBC as they go through microcirculation brain, heart, pancreas may also be involved atypical HUS no diarrhoeal prodrome may be familial often relapses high risk of HTN & chronic renal failure high mortality Mx typical HUS (diarrhoea-assoc) supportive therapy dialysis follow up may be persistent proteinuria development of HTN atypical HUS or cerebral involvement plasma exchange/infusions unproven efficacy vasculitis embolus renal vein thrombosis
3.2.3 tubular acute tubular necrosis (ATN) ischaemic obstructive
3.2.4 glomerular glomerulonephritis
3.2.5 interstitial interstitial nephritis pyelonephritis
3.3 postrenal
3.3.1 from urinary obstruction congenital e.g post urethral valves 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 to ID obstruction of urinary tract small kidneys of chronic renal failure large bright kidneys w/ loss of cortical medullary differentiation typical of acute process
5.3 prerenal ARF
5.3.1 suggested by hypovolaemia fractional excretion of Na+ very low as body tries to retain fluid hypovol needs urgent correction to avoid acute renal tubular necrosis fluid replacement circulatory support
5.4 renal ARF
5.4.1 if circulatory overload present to correct Na+ & water balance, gradually restrict fluid intake diuretic
5.4.2 high calorie, normal protein feed decreases catabolism, uraemia & hyperkalaemia
5.4.3 emergency mx of metabolic abnormalities metabolic acidosis sodium bicarbonate hyperphosphataemia calcium carbonate dietary restriction hyperkalaemia calcium gluconate if ECG changes calcium exchange resin glucose & insulin dietary restriction dialysis
5.4.4 if cause of renal failure not obv renal biopsy to ID rapidly progressive glomerulonephritis may need immediate immunosuppresion
5.4.5 commonest causes of ARN in kids in UK haemolytic uraemic syn acute tubular necrosis multisys failure in ICU ff cardiac surgery
5.5 postrenal ARF
5.5.1 needs assessment of site of obstruction
5.5.2 relief of obstruction nephrostomy bladder catheterisation
5.5.3 surgery can be done once fluid vol & electrolyte abnormalities corrected
5.6 dialysis
5.6.1 indications failure of conservative mx hyperkalaemia severe hypo or hypernatraemia pul oedema or HTN severe acidosis multisys failure
5.6.2 peritoneal
5.6.3 haemodialysis used if plasma exchange part of Rx continuous arteriovenous or venovenous if cardiac decompenation or hypercatabolism
6 generally good prognosis for renal recover unless complicating a life-threatening condition

Media attachments