Paediatric acute kidney injury (AKI) is essentially the same as AKI in adults. If you would like a more detailed overview of AKI please look at the document on it which can be found here.
In this document we shall look at some risk factors, causes and referral criteria for AKI in children.
⚠️ Risk factors
- Nephro-urological disease
- Cardiac disease
- Liver disease
- Malignancy and/or bone marrow transplant
- Medications - most commonly antimicrobials (especially ß-lactam, aminoglycosides), NSAIDs, and chemotherapeutic agents.
💦 Causes of AKI in children:
We can again divide the causes into pre-renal, renal and post-renal causes:
Pre-renal causes:
- Hypovolaemia - secondary to:
- Burns
- Sepsis
- Nephrotic syndrome
- Acute gastroenteritis
- Circulatory failure and cardiac failure.
Renal causes:
- Vascular
- Haemolytic uraemic syndrome
- Vasculitis
- Embolisms
- Renal vein thrombosis
- Tubular
- Acute tubular necrosis
- Ischaemia
- Toxins
- Obstructions
- Glomerular
- Glomerulonephritis
- Interstitial
- Interstitial nephritis
- Pyelonephritis
Post-renal causes:
- Congenital obstruction - such as posterior urethral valves.
✍️ Referral criteria
Indications for an immediate referral for nephrology are as follows:
- Potassium >6.5mmol/L
- Oliguria and plasma sodium <125mmol
- Pulmonary oedema or hypertension that is unresponsive to diuretics.
- Plasma urea >40mmol/L that is unresponsive to a fluid challenge.
Paediatric ICU can be considered too.