Pediatric emergency medicine trisk 2901 2901

granulomatosis with polyangiitis may have AIN with or without diseaseassociated glomerular disease. Patients with Sjögren syndrome and
sarcoidosis also have increased risk.
Presenting symptoms are often nonspecific and may indicate generalized
AKI, such as nausea and malaise. Approximately 50% of patients will have
oliguria. Systemic symptoms such as rash or fever may be present. A small
portion of patients may complain of gross hematuria.
Clinical assessment. The clinical assessment should focus on identifying
potential symptoms of kidney dysfunction and possible underlying causes
for AIN. A detailed medication history including current and recently
discontinued drugs should be obtained. The physical examination should
look for signs of systemic infections or diseases that could act as the
causative factor. Nephrotic syndrome is rare in the setting of AIN.
Proteinuria and edema are unlikely to be present. Depending on the degree
of underlying AKI, blood pressure may be normal.
Microscopic examination of the urine may reveal the presence of red
blood cells or white blood cell casts. Eosinophiluria defined by >1%
eosinophils on the urine white blood cell differential may be suggestive of
AIN but is not specific. Furthermore, absence of this finding has poor
negative predictive value. Serum creatinine levels are almost universally
elevated, and serum electrolytes should be measured. Eosinophilia is
evident on a CBC in approximately one-third of cases.
Management. If an offending medication is identified as the likely cause,
it should be discontinued immediately if not already done so. Underlying
infections should be treated. Patients may require management of fluid,
electrolyte, and acid–base disturbances, depending on the level of
underlying renal dysfunction.

Rhabdomyolysis
Goals of Treatment
The goals of treatment for rhabdomyolysis include identifying and treating
the underlying cause of the rhabdomyolysis, if possible. The prevention of

AKI should be achieved via aggressive hydration and measures aimed at the
mitigation of renal and electrolyte abnormalities that do occur must be
taken. Pain control may be required.