Fifteen-minute consultation: how to identify and treat children with acute kidney injury

2021 ◽  
pp. edpract-2020-319928
Author(s):  
Maura Scott ◽  
Grace McCall
Keyword(s):  
Acute Kidney Injury ◽  
Fluid Management ◽  
Kidney Injury ◽  
Case Presentation ◽  
Mortality And Morbidity ◽  
Fluid Status ◽  
Close Observation ◽  
Long Term Follow Up

Acute kidney injury (AKI) is under-recognised in children and neonates. It is associated with increased mortality and morbidity along with an increased incidence of chronic kidney disease in adulthood. It is important that paediatricians are able to recognise AKI quickly, enabling prompt treatment of reversible causes. In this article, we demonstrate an approach to recognising paediatric AKI, cessation of nephrotoxic medication, appropriate investigations and the importance of accurately assessing fluid status. The mainstay of treatment is attempting to mimic the kidneys ability to provide electrolyte and fluid homeostasis; this requires close observation and careful fluid management. We discuss referral to paediatric nephrology and the importance of long-term follow-up. We present an approach to AKI through case-presentation.

scholarly journals Long-Term Follow-Up of Contrast-Induced Acute Kidney Injury: A Study from a Developing Country

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Ashraf O. Oweis ◽  
Sameeha A. Alshelleh ◽  
Nesreen Saadeh ◽  
Mohamad I. Jarrah ◽  
Rasheed Ibdah ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Albumin ◽  
Univariate Analysis ◽  
Kidney Injury ◽  
Study Groups ◽  
Long Term Follow Up ◽  
Patients At Risk ◽  
Percutaneous Catheterization

Introduction. Contrast-induced acute kidney injury (CI-AKI) is a worldwide known complication related to the use of contrast media with either imaging or angiography; it carries its own complications and effect on both morbidity and mortality; early identification of patients at risk and addressing modifiable risk factors may help reducing risk for this disease and its complications. Methods. This was a prospective observational study, where all patients admitted for cardiac catheterization between June 2015 and January 2016 were evaluated for CI-AKI. There were two study groups: contrast-induced acute kidney injury (CI-AKI) group, and noncontrast-induced acute kidney injury (non-CI-AKI) group. Results. Patients ( n = 202 ) were included and followed up for 4 years. Death and development of chronic kidney disease (CKD) need for another revascularization were the end points. The incidence of CI-AKI was 14.8%.In univariate analysis, age ( P = 0.016 ) and serum albumin at admission ( P = 0.001 ) were statistically significant predictors of overall death. Age ( P = 0.002 ), HTN ( P = 0.002 ), DM ( P = 0.02 ), and the use of diuretics ( P = 0.001 ) had a statistically significant impact on eGFR. The rate of recatheterization was not statistically significant between the two groups (61 (35.5%) for the non-CI-AKI vs. 12 (40%) for the other group; P = 0.63 ). Some inflammatory markers (NGAL P = 0.06 , IL-19 P = 0.08 ) and serum albumin at admission P = 0.07 had a trend toward a statistically significant impact on recatheterization. Death ( P = 0.66 ) and need for recatheterization ( P = 0.63 ) were not statistically different between the 2 groups, while the rate of eGFR decline in for the CI-AKI was significant ( P = 0.004 ). Conclusion. CI-AKI is a common complication post percutaneous catheterization (PCI), which may increase the risk for CKD, but not death or the need for recatheterization. Preventive measures must be taken early to decrease the morbidity.

Acute kidney injury after transcatheter aortic valve implantation and mortality risk—long-term follow-up

2018 ◽  
Vol 35 (3) ◽  
pp. 433-438 ◽  
Author(s):  
Orit Kliuk-Ben Bassat ◽  
Ariel Finkelstein ◽  
Samuel Bazan ◽  
Amir Halkin ◽  
Itzhak Herz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Valve ◽  
Mortality Risk ◽  
Kidney Injury ◽  
Transcatheter Aortic Valve ◽  
Long Term Follow Up ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Acute kidney injury (AKI) complicating transcatheter aortic valve implantation (TAVI) is relatively frequent and associated with significant morbidity. Previous studies have shown a higher 30-day and 1-year mortality risk in patients with periprocedural AKI. Our aim was to identify the prognostic impact of periprocedural AKI on long-term follow-up. Methods This is a single-center prospective study evaluating patients undergoing TAVI for severe aortic stenosis. AKI was defined according to the Valve Academic Research Consortium 2 definition, as an absolute increase in serum creatinine ≥0.3 mg/dL or an increase >50% within the first week following TAVI. Mortality data were compared between patients who developed AKI and those who did not. Logistic and Cox regressions were used for survival analysis. Results The final analysis included 1086 consecutive TAVI patients. AKI occurred in 201 patients (18.5%). During the follow-up period, 289 patients died. AKI was associated with an increased risk of 30-day mortality {4.5 versus 1.9% in the non-AKI group; hazard ratio [HR] 3.70 [95% confidence interval (CI) 1.35–10.13]}. Although 1-year mortality was higher in the AKI group in univariate analysis, it was not significant after a multivariate regression. AKI was a strong predictor of longer-term mortality [42.3 versus 22.7% for 7-year mortality; HR 1.71 (95% CI 1.30–2.25)]. In 189 of 201 patients we had data regarding recovery from AKI up to 30 days after discharge. In patients with recovery from AKI, the mortality rate was lower (38.2 versus 56.6% in the nonrecovery group; P = 0.022). Conclusions Periprocedural AKI following TAVI is a strong risk factor for short-term as well as long-term mortality (up to 7 years). Therefore more effort is needed to reduce this complication.

scholarly journals Prognosis and long-term outcomes of acute kidney injury due to snake envenomation

2019 ◽  
Vol 13 (4) ◽  
pp. 564-570 ◽  
Author(s):  
P S Priyamvada ◽  
Challa Jaswanth ◽  
Bobby Zachariah ◽  
Satish Haridasan ◽  
Sreejith Parameswaran ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Function ◽  
Cox Regression ◽  
Kidney Injury ◽  
Case Definitions ◽  
Snake Envenomation ◽  
Long Term Follow Up

Abstract Background Snakebite is a common occupational hazard in tropical countries. To date, the literature on snakebite-related acute kidney injury (AKI) has been limited by retrospective study designs, lack of uniformity in case definitions of AKI and limited follow-up. This study aims to identify the in-hospital outcomes and long-term changes in kidney function that follow haemotoxic envenomation. Methods All adult patients admitted with AKI following haemotoxic envenomation from January 2016 to June 2017 were recruited and followed up until July 2018. Predictors of in-hospital mortality was assessed. Long-term follow-up data on kidney function were collected from survivors. Results In total, 184 patients with haemotoxic envenomation and AKI were recruited. The mean age of the subjects was 42.2 years [95% confidence interval (CI) 40.3–44.7]. The majority were male (71.2%). The mortality of patients with haemotoxic envenomation was 21.5%. The mortality was considerably higher in patients with Kidney Disease: Improving Global Outcomes (KDIGO) Stage 3 AKI [relative risk (RR) 4.45 (95% CI 1.14–17.42)] and those who met KDIGO urine output criteria [RR 20.45 (95% CI 2.84–147.23)]. A Cox regression model identified mechanical ventilation [odds ratio (OR) 5.59 (95% CI 2.90–10.81)], hypotension [OR 2.48 (95% CI 1.31–4.72)] and capillary leak syndrome [OR 2.02 (95% CI 1.05–3.88)] as independent predictors of mortality. Long-term follow-up data were available for 73 patients. A total of 21 patients (28.7%) developed adverse renal outcomes (glomerular filtration rate <60 mL/min/1.73 m2, urine albumin excretion >30 mg/g and new-onset hypertension or prehypertension). Conclusions AKI resulting from snake envenomation is associated with considerable risk of mortality. The greater the AKI stage the greater the likelihood of mortality. One-third of patients with AKI developed long-term complications like chronic kidney disease, prehypertension and hypertension over the follow-up period.

scholarly journals Outcome of Acute Kidney Injury with Different Treatment Options: Long-Term Follow-up

2010 ◽  
Vol 5 (10) ◽  
pp. 1755-1762 ◽  
Author(s):  
An M. Van Berendoncks ◽  
Monique M. Elseviers ◽  
Robert L. Lins ◽  
Keyword(s):  
Acute Kidney Injury ◽  
Treatment Options ◽  
Kidney Injury ◽  
Long Term Follow Up
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