Acute kidney injury (AKI) in children

Acute kidney injury (AKI) can also affect children, and it is a serious condition that requires prompt medical attention. AKI in children shares many similarities with AKI in adults but may have unique causes, presentations, and considerations due to the differences in pediatric physiology. Here are some key points about AKI in children:

Causes of AKI in Children: The causes of AKI in children can be broadly categorized into three groups, similar to AKI in adults:

Prerenal Causes: These causes relate to reduced blood flow to the kidneys and can include:
- Dehydration due to vomiting, diarrhea, or inadequate fluid intake
- Low blood volume from bleeding or shock
- Heart conditions affecting cardiac output
Intrinsic Renal Causes: These causes involve damage to the kidney tissue itself and can include:
- Acute tubular necrosis (ATN) often due to infections, toxins, or medications
- Glomerulonephritis (inflammation of the glomeruli)
- Hemolytic uremic syndrome (HUS)
- Thrombotic thrombocytopenic purpura (TTP)
Postrenal Causes: These causes result from urinary tract obstructions and can include:
- Kidney stones
- Ureteral obstructions
- Bladder outlet obstructions

Symptoms and Presentation: Children with AKI may present with symptoms such as:

Decreased urine output
Swelling (edema), especially around the eyes, ankles, and legs
Fatigue and weakness
Decreased appetite
Nausea and vomiting
High blood pressure (hypertension) or low blood pressure (hypotension)
Irritability, restlessness, or altered mental status

The presentation of AKI in children can vary depending on the underlying cause and the child’s age. Infants and younger children may not be able to communicate their symptoms, making it crucial for parents and caregivers to watch for signs of illness.

Diagnosis and Evaluation: The diagnosis of AKI in children involves a combination of clinical evaluation, laboratory tests (e.g., serum creatinine, blood urea nitrogen, electrolyte levels), and imaging studies (e.g., ultrasound) to determine the cause and severity of the condition. Urinalysis and urine output measurement are also important diagnostic tools.

Treatment and Management: The treatment of AKI in children aims to address the underlying cause, maintain adequate fluid and electrolyte balance, and support kidney function. Treatment strategies may include:

Rehydration with intravenous fluids to improve blood flow to the kidneys
Adjusting medications that may be contributing to kidney damage
Treatment of infections or underlying medical conditions
Monitoring and managing electrolyte imbalances
Dialysis in severe cases when the kidneys cannot adequately filter waste products from the blood

The management of AKI in children often requires close collaboration between pediatric nephrologists, pediatricians, and other healthcare providers. Children with AKI may need ongoing monitoring and follow-up care to assess kidney function and ensure recovery.

Early recognition and intervention are vital to improving outcomes for children with AKI. Parents and caregivers should seek medical attention promptly if they suspect their child may be experiencing symptoms of AKI or if they have concerns about their child’s health.