Pediatric emergency medicine trisk 2884 2884

Children presenting with AKI may have signs of systemic fluid
overload but be intravascularly dehydrated.
Electrolyte and acid–base abnormalities may be present upon
presentation and may need to be emergently addressed.
Patients may require RRT if intrinsic renal function is unable to
maintain fluid and electrolyte balance.
Consultation with a nephrologist will help guide evaluation and
therapeutic choices.

Current Evidence
AKI, previously termed acute renal failure, is an abrupt decrease in the
GFR with impairment of creatinine clearance. However, there may be a
time lag between the onset of injury and clinically detectable changes in
serum creatinine. Depending on the severity of the injury, there may be
altered water and electrolyte excretion as well as disturbances of metabolic
and acid–base regulation. In mild cases, nonoliguric AKI may be
asymptomatic and only detected when serum laboratory studies are
performed. When severe, oliguric AKI may result in profound
derangements of electrolyte and volume balance necessitating the initiation
of RRT.
The Schwartz formula allows estimation of the GFR in children based on
serum creatinine, patient length, age, and gender ( Table 100.13 ). It should
be noted that this formula tends to overestimate GFR, and this
overestimation increases with decreasing GFR.
AKI may be classified as prerenal, intrinsic renal, and postrenal. Prerenal
AKI can result from intravascular volume depletion or reduced effective
circulating volume. Volume depletion may occur in the setting of
uncompensated fluid losses from a variety of sources including bleeding,
urination, gastrointestinal output, and cutaneous losses from burns or
excessive sweating. Intravascular volume depletion may also develop when
fluid shifts out of the vascular space into the interstitial space such as in the

setting of hypoalbuminemia or during systemic inflammatory response
syndrome (SIRS). Decreased effective circulating volume may be present in
heart failure or distributive shock. Intrinsic renal disease can result from