Current opinion in pediatrics
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Curr. Opin. Pediatr. · Apr 2011
ReviewEvaluation and management of critically ill children with acute kidney injury.
This review will highlight recent studies on the diagnosis of acute kidney injury (AKI), review the differential diagnosis, highlight the importance of cumulative fluid overload and provide key management strategies for the pediatric patient with AKI. ⋯ Categorical definitions of AKI have shown that higher AKI portends poor outcomes even with adjustment for severity of illness and other confounders. Cumulative fluid overload independently predicts poor outcomes. Strategies to prevent and/or treat fluid overload are likely to improve outcomes.
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Curr. Opin. Pediatr. · Apr 2011
ReviewContinuous renal replacement therapy: mechanism of clearance, fluid removal, indications and outcomes.
Continuous renal replacement therapy (CRRT) is the most common dialysis modality provided to critically ill children with acute kidney injury (AKI). However, confusion still exists with respect to CRRT terminology and the optimal use of this modality across the entire pediatric disease and age spectrum. ⋯ CRRT represents an essential dialytic modality for the pediatric nephrologist caring for critically ill children. Current data suggest that earlier initiation of CRRT to prevent excessive fluid accumulation may lead to improved survival in critically ill children, but prospective trials are required to test this hypothesis directly.
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To present the latest data that demonstrate how climate change affects children's health and to identify the principal ways in which climate change puts children's health at risk. ⋯ Through many pathways, and in particular via placing additional stress upon the availability of food, clean air, and clean water and by potentially expanding the burden of disease from certain vector-borne diseases, climate change represents a major threat to child health. Pediatricians have already seen and will increasingly see the adverse health effects of climate change in their practices. Because of this, and many other reasons, pediatricians have a unique capacity to help resolve the climate change problem.
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Ingestions and iatrogenic administration of drugs are all too common causes of acute kidney injury. This review will discuss these preventable causes of acute kidney injury. ⋯ Knowledge of the drugs that cause acute kidney injury and how this injury is manifested can lead to improved diagnosis and treatment with the ultimate goal of prevention.