Diagnostic ultrasound ( PDFDrive )

1796 PART V Pediatric Sonography
Common Causes of Acute Kidney Injury
PRERENAL FAILURE
Decreased true intravascular volume
Decreased effective intravascular volume
INTRINSIC RENAL DISEASE
Acute tubular necrosis (vasomotor neuropathy)
Hypoxic or ischemic insults
Drug induced
Toxin mediated
Endogenous toxins—hemoglobin, myoglobin
Exogenous toxins—ethylene glycol, methanol
URIC ACID NEPHROPATHY AND TUMOR LYSIS
SYNDROME
INTERSTITIAL NEPHRITIS
Drug induced
Idiopathic
GLOMERULONEPHRITIS
VASCULAR LESIONS
Renal artery thrombosis
Renal vein thrombosis
Cortical necrosis
Hemolytic uremic syndrome
HYPOPLASIA OR DYSPLASIA WITH OR WITHOUT
OBSTRUCTIVE UROPATHY
Idiopathic
Exposure to nephrotoxic drugs in utero
HEREDITARY RENAL DISEASE
Autosomal dominant polycystic kidney disease
Autosomal recessive polycystic kidney disease
Alport syndrome
Sickle cell nephropathy
Juvenile nephronophthisis
OBSTRUCTIVE UROPATHY AND LOWER TRACT
LESIONS
Obstruction in a solitary kidney
Bilateral ureteral obstruction
Urethral obstruction
Bladder rupture
With permission from Andreoli S. Clinical evaluation of acute kidney injury in children. In: Avner ED, editor. Pediatric nephrology. 6th ed. Berlin:
Springer-Verlag; 2009. 81
occur in more severe cases. 80 Decreased renal cortical echogenicity
is typical of acute cortical necrosis.
Nephrotoxic drugs commonly associated with AKI include
antibiotics, chemotherapeutic agents, and nonsteroidal antiinlammatory
medications. Some medications such as aminoglycoside
antibiotics cause tubular injury. Methicillin and other
penicillin analogues, cimetidine, sulfonamides, rifampin, and
nonsteroidal antiinlammatory drugs may cause acute interstitial
nephritis, which in some cases leads to a hypersensitivity
reaction with development of antitubular basement membrane
antibodies.
Children with B-cell lymphoma and acute lymphocytic
leukemia are at risk for the development of uric acid nephropathy
and tumor lysis syndrome. In patients with septic shock, AKI
can develop from hypotension, leading to renal ischemia and
ATN. 80
FIG. 52.32 Hemorrhagic Cystitis Caused by the Polyomavirus
BK Virus in Patient With Leukemia. Transverse bladder image shows
thick-walled bladder containing echogenic debris and blood clot (*).
cases, the kidneys may appear normal or may demonstrate slightly
increased renal cortical echogenicity. Loss of corticomedullary
diferentiation can occur. Doppler low may be normal in mild
disease, whereas poor peripheral perfusion and diminished arterial
diastolic low due to increased peripheral vascular resistance
Chronic Kidney Disease
he classiication of CKD published by the National Kidney
Foundation Kidney Disease Outcomes Quality Initiative is based
on estimated glomerular iltration rate and is applicable to children
older than 2 years and to adults 82 (Table 52.7). he most common
causes of pediatric CKD in North America are congenital disorders
such as obstructive uropathy, renal dysplasia, and relux
nephropathy. In contrast, in Japan, 34% of pediatric CKD is
due to glomerulonephritis, primary focal segmental glomerulosclerosis,
and immunoglobulin A nephropathy. In Jordan
and Iran, where consanguinity is more common, heritable
disorders such as cystic kidney disease, primary hyperoxaluria,
cystinosis, Alport syndrome, and congenital nephrotic syndrome
represent a greater proportion of cases of CKD. In the