Acute kidney injury (Pediatrics)
Summary/Definition
Acute kidney injury is a sudden decrease in their functional activity. The kidneys play an important role in the excretion of metabolic products from the body through urine. However, when acute kidney injury occurs, their ability to perform this function decreases, which leads to the accumulation of metabolic products in the body. In addition, the kidneys regulate the balance of water and electrolytes in the body, and with acute kidney injury, this balance is also disrupted. Acute kidney injury
can occur for various reasons, including severe diarrhea, bleeding, severe infectious diseases, dehydration or circulatory disorders, for example, heart failure, as well as infectious diseases, including epidemic hemorrhagic fever, yersiniosis gastroenteritis, escherichia coli infection (hemolytic uremic syndrome) and the use of contrast agents. Other risk factors include nephrotoxic antibiotics, nephrotoxic anticancer drugs, certain medicinal herbs, nephrotoxic medications, and certain foods, such as poisonous plants. Acute kidney injury can also occur after surgical operations, for example, heart surgery, or in the presence of predisposing factors such as acute nephritis, chronic nephritis and various kidney diseases, including urolithiasis. Acute kidney injury can be divided into three main categories depending on the mechanism of development. Diarrhea, vomiting, bleeding, shock, deterioration of cardiac function, nephrogenic acute nephropathy caused by a decrease in water supply to the kidneys, and nephrogenic acute nephropathy caused by nephrotoxic drugs or food intake, side effects of contrast agents, endogenous acute nephropathy caused by glomerular or soy tubule disease, etc., and nephrogenic acute nephropathy caused by obstruction of the urinary tract caused by urolithiasis or tumors, etc.
Symptoms
Clinical manifestations of acute kidney injury are diverse and depend on the cause of the lesion, the degree of deterioration of kidney function and the rate of progression. Usually there is a decrease in urine volume, but there are also cases when urination remains unchanged, even with deterioration of kidney function. Symptoms can range from feeling tired and weak for no obvious reason to the complete absence of any obvious manifestations. With the deterioration of the body’s ability to regulate water and electrolytes, electrolyte imbalances such as hyperkalemia and hypocalcemia occur, as well as acidosis associated with electrolyte and acid-base balance disorders. A decrease in the ability to regulate the water balance can lead to pulmonary edema and an increase in blood pressure, which reflects disorders of the cardiovascular system. Anemia or thrombocytopenia can lead to light bleeding (hematological disorders) and be accompanied by symptoms such as loss of appetite, nausea, flatulence, vomiting and diarrhea, which reflects disorders of the digestive system. As kidney injury worsens, disturbances of consciousness, convulsions, character changes, psychoses and other neurological symptoms may occur, indicating disorders in the nervous system.
Diagnostics
Various medical procedures and tests are performed to diagnose acute kidney injury, including blood and urine tests, ultrasound or imaging examination, as well as kidney biopsy. In case of suspected acute kidney injury, it is important to carefully study the anamnesis to identify possible causes of impaired blood flow in the kidneys, especially in the presence of symptoms of dehydration, such as loss of skin elasticity or dry mucous membranes. These symptoms may be accompanied by such phenomena as vomiting, diarrhea, bleeding, sepsis, etc. It is also important to collect a history of taking nephrotoxic drugs and contrast agents. A medical examination includes measuring the patient’s blood pressure and weight, as well as evaluating the skin for petechiae and purpura, swelling of the face or limbs, and the presence of ascites in the abdomen. Urine tests can distinguish acute kidney injury from renal failure by measuring the specific gravity of urine, osmotic pressure and sodium concentration in urine, and also help to identify abnormalities such as proteinuria and hematuria. Blood tests include determination of the content of urea nitrogen (BUN) and creatinine (Cr) in the blood. In some cases, additional imaging studies may be required, for example, kidney ultrasound, Dopplerography, computed tomography or angiography, as well as kidney biopsy.
Treatment and course of the disease
The possibility of functional recovery in acute kidney injury depends on the type of disease that led to the damage, the presence of concomitant diseases of the patient and the current condition. With timely initiation of appropriate treatment, complete recovery is achieved in 90% of cases, while approximately 5-10% of cases develop chronic renal failure requiring permanent dialysis or kidney transplantation. In the treatment of acute kidney injury, it is critical to identify the cause and conduct appropriate therapy. In addition, it is important to maintain a normal level of hydration of the body, consume the necessary amount of fluid to stimulate urine excretion, as well as provide adequate nutrition to maintain immunity and skeletal muscle health, as well as to prevent complications such as fluid imbalance, hyperkalemia and infections.
The probability of subsequent functional recovery in acute kidney injury depends on the underlying disease, the presence of concomitant diseases of the patient and the current condition.
The medical treatment of acute kidney injury depends on the underlying disease that caused this condition. For example, if acute kidney injury is associated with sepsis, then treatment involves the use of antibiotics. However, it is worth noting that there is no such medicine that could restore kidney function on its own. If symptoms of acute kidney injury such as high blood pressure, electrolyte imbalance or seizures occur, then medication is required to control them. In such cases, antibiotics can be used to fight infection, diuretics to stimulate the excretion of excess fluid, blood pressure regulators to control the level of calcium or magnesium, as well as antispasmodics. Non-drug treatments include hydration procedures and fluid restriction, as well as dialysis if kidney function does not recover or deteriorates. Dialysis can include various methods, for example, hemodialysis, peritoneal dialysis and continuous renal replacement therapy (CRRT), and its purpose depends on the clinical situation and the patient’s condition.
