Acute Kidney Injury in In Paediatrics

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Serum Creatinine has many limitations: • Differs with age, sex, dietary intake, muscle mass etc. • Doesn’t reflect dynamic changes only increases when there is substantial loss of renal function. • 10 – 40% of creatinine is cleared by tubular secretion in the urine – therefore has the potential to hide a considerable decline in GFR. • Several drugs impair creatinine secretion, eg. Trimethoprim. • Once a patient receives dialysis SCr easily dialysed can no longer be used as a marker • In neonates • First few days reflect mother’s creatinine; • Therafter, SCr improves at different rates depending on gestational age (Bagshaw S, et al: Crit Care Med 2008; 36(4):S152-S158) (Askenazi D; Curr Opin Pediatr 23: 201-207)
Biomarkers • The quest to find early markers of AKI is important • Newer biomarkers include: • Neutrophil Gelatinose Associated Lipocalin (NGAL) • Cystatin C • Kidney Injury Molecule – 1 (KIM-1) • IL-18.
Page 1 and 2: Acute Kidney Injury In Paediatrics
Page 3 and 4: What is AKI? • A sudden deteriora
Page 5 and 6: Long Term Outcomes • At 3 to 5-yr
Page 7 and 8: RIFLE vs AKIN
Page 9 and 10: pRIFLE CLASS Change in eCCl Urine O
Page 11: Biomarkers • The pRIFLE, RIFLE an
Page 15 and 16: NGAL • Urine NGAL > 50ug/ml predi
Page 17 and 18: IL-18 • Induced in the proximal r
Page 19 and 20: Management • Prevention of AKI is
Page 21 and 22: Ways to Prevent Contrast-Induced Ne
Page 23 and 24: Ways to Prevent Contrast-Induced
Page 25 and 26: Common Nephrotoxins in ICU EXOGENOU
Page 27 and 28: Management General principles of
Page 29 and 30: Maintain Renal Perfusion Vasopresso
Page 31 and 32: Maintain Renal Perfusion • Renal
Page 33 and 34: Maintain Renal Perfusion Choice of
Page 35 and 36: Cumulative Fluid Overload • The p
Page 37 and 38: Nutritional Support • Nutrition i
Page 39 and 40: Renal Replacement Therapy • Curre
Page 41 and 42: Timing of RRT • In paediatrics, t
Page 43 and 44: Differences between adult and • P
Page 45 and 46: Differences between adult and • P
Page 47 and 48: With CRRT • We must continually w
Page 49 and 50: Conclusions • Management of AKI i
Page 51 and 52: Conclusion • However, paediatric

Acute Kidney Injury in In Paediatrics

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