• Elizabeth Yen, Niel F Miele, Joseph G Barone, Rachana Tyagi, and Lynne S Weiss.
• From the *Departments of Pediatrics, and †Emergency Medicine, and ‡Child Health Institute of New Jersey, Rutgers-Robert Wood Johnson University Hospital, The Bristol-Myers Squibb Children's Hospital, New Brunswick, NJ.
• Pediatr Emerg Care. 2014 Nov 1;30(11):826-8.

AbstractAcute kidney injury (AKI) is characterized by the acute nature and the inability of kidneys to maintain fluid homeostasis as well as adequate electrolyte and acid-base balance, resulting in an accumulation of nitrogenous waste and elevation of serum blood urea nitrogen and creatinine values. Acute kidney injury may be a single isolated event, yet oftentimes, it results from an acute chronic kidney disease. It is critical to seek out the etiology of AKI and to promptly manage the underlying chronic kidney disease to prevent comorbidities and mortality that may ensue. We described a case of a 16-year-old adolescent girl with Down syndrome who presented with AKI and electrolyte aberrance.Abdominal and renal ultrasounds demonstrated a significantly dilated bladder as well as frank hydronephrosis and hydroureter bilaterally. Foley catheter was successful in relieving the obstruction and improving her renal function. However, a magnetic resonance imaging was pursued in light of her chronic constipation and back pain, and it revealed a structural defect (tethered cord) that underlies a chronic process that was highly likely contributory to her AKI. She was managed accordingly with a guarded result and required long-term and close monitoring.

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