Acute Kidney Injury in Pediatric Patients .pdf


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Acute Kidney Injury in
Pediatric Patients: Diagnosis
and Management in the
Emergency Department
Pediatric acute kidney injury is a condition that is underdiag­nosed
among children seen in the emergency department, and it has been associated with significant morbidity and mortality, including increased
risk for chronic kidney disease. The most common etiologies in pediatric patients are now known to be due to hypovolemia, sepsis, shock,
and cardiac dysfunction. This issue compares 3 classification systems
for the diagnosis and staging of acute kidney injury and reviews the
etiologies that lead to kidney injury in children. The management of
pediatric acute kidney injury focuses on identifying patients at high
risk, monitoring intravascular volume status, avoiding nephrotoxic
medica­tion exposure, and involving a pediatric nephrologist once
acute kidney injury is diagnosed.

Adam E. Vella, MD, FAAP
Associate Professor of Emergency
Medicine, Pediatrics, and Medical
Education, Director Of Pediatric
Emergency Medicine, Icahn School
of Medicine at Mount Sinai, New
York, NY

Associate Editor-in-Chief

Authors
Daniel Mohrer, MD
Pediatric Resident, Yale-New Haven Children’s Hospital, New
Haven, CT
Melissa Langhan, MD, MHS
Associate Professor of Pediatrics and Emergency Medicine;
Fellowship Director, Director of Education, Pediatric Emergency
Medicine, Yale University School of Medicine, New Haven, CT
Peer Reviewers

Abstract

Editor-in-Chief

May 2017

Volume 14, Number 5

Ilene Claudius, MD
Associate Professor, Department
of Emergency Medicine and
Pediatrics, USC Keck School of
Medicine, Los Angeles, CA
Ari Cohen, MD, FAAP
Chief of Pediatric Emergency
Medicine, Massachusetts General
Hospital; Instructor in Pediatrics,
Harvard Medical School, Boston, MA

Vincent J. Wang, MD, MHA
Marianne Gausche-Hill, MD, FACEP,
Professor of Pediatrics, Keck
FAAP, FAEMS
School of Medicine of the
Medical Director, Los Angeles
University of Southern California;
County EMS Agency; Professor of
Associate Division Head, Division
Clinical Emergency Medicine and
of Emergency Medicine, Children's
Pediatrics, David Geffen School of
Hospital Los Angeles, Los Angeles,
Medicine at UCLA; EMS Fellowship
CA
Director, Harbor-UCLA Medical
Center, Department of Emergency
Editorial Board
Medicine, Los Angeles, CA
Jeffrey R. Avner, MD, FAAP
Michael J. Gerardi, MD, FAAP,
Professor of Pediatrics and Chief
FACEP, President
of Pediatric Emergency Medicine,
Associate Professor of Emergency
Albert Einstein College of Medicine,
Medicine, Icahn School of Medicine
Children’s Hospital at Montefiore,
at Mount Sinai; Director, Pediatric
Bronx, NY
Emergency Medicine, Goryeb
Children's Hospital, Morristown
Steven Bin, MD
Medical Center, Morristown, NJ
Associate Clinical Professor,
UCSF School of Medicine; Medical Sandip Godambe, MD, PhD
Director and Interim Chief, Pediatric Chief Quality and Patient Safety
Emergency Medicine, UCSF Benioff
Officer, Professor of Pediatrics and
Children's Hospital, San Francisco,
Emergency Medicine, Attending
CA
Physician, Children's Hospital of the
King's Daughters Health System,
Richard M. Cantor, MD, FAAP,
Norfolk, VA
FACEP
Professor of Emergency Medicine
Ran D. Goldman, MD
and Pediatrics; Director, Pediatric
Professor, Department of Pediatrics,
Emergency Department; Medical
University of British Columbia;
Director, Central New York Poison
Research Director, Pediatric
Control Center, Golisano Children's
Emergency Medicine, BC Children's
Hospital, Syracuse, NY
Hospital, Vancouver, BC, Canada

Jason Greenberg, MD, MHS
Clinical Instructor, Department of Pediatrics, Yale University School
of Medicine, New Haven, CT
Jeffrey Saland, MD
Chief, Pediatric Nephrology and Hypertension, Icahn School of
Medicine at Mount Sinai, New York, NY
Rene G. VanDeVoorde III, MD, FAAP
Assistant Professor, Pediatrics, Vanderbilt School of Medicine,
Nashville, TN
Bernarda Viteri, MD
Fellow, Pediatric Nephrology and Hypertension, Icahn School of
Medicine at Mount Sinai, New York, NY
Prior to beginning this activity, see “Physician CME Information”
on the back page.

Alson S. Inaba, MD, FAAP
Garth Meckler, MD, MSHS
Pediatric Emergency Medicine
Associate Professor of Pediatrics,
Specialist, Kapiolani Medical Center
University of British Columbia;
for Women & Children; Associate
Division Head, Pediatric Emergency
Professor of Pediatrics, University
Medicine, BC Children's Hospital,
of Hawaii John A. Burns School of
Vancouver, BC, Canada
Medicine, Honolulu, HI
Joshua Nagler, MD, MHPEd
Madeline Matar Joseph, MD, FACEP, Assistant Professor of Pediatrics
FAAP

and Emergency Medicine, Harvard
Professor of Emergency Medicine
Medical School; Fellowship Director,
and Pediatrics, Chief and Medical
Division of Emergency Medicine,
Director, Pediatric Emergency
Boston Children’s Hospital, Boston,
Medicine Division, University
MA
of Florida College of MedicineJames Naprawa, MD
Jacksonville, Jacksonville, FL
Attending Physician, Emergency
Stephanie Kennebeck, MD
Department USCF Benioff
Associate Professor, University of
Children's Hospital, Oakland, CA
Cincinnati Department of Pediatrics,
Joshua Rocker, MD
Cincinnati, OH
Associate Chief, Division of
Anupam Kharbanda, MD, MS
Pediatric Emergency Medicine,
Chief, Critical Care Services
Cohen Children's Medical Center;
Children's Hospitals and Clinics of
Assistant Professor of Emergency
Minnesota, Minneapolis, MN
Medicine and Pediatrics, Hofstra
Northwell School of Medicine, New
Tommy Y. Kim, MD, FAAP, FACEP
Hyde Park, NY
Associate Professor of Pediatric
Emergency Medicine, University of
Steven Rogers, MD
California Riverside School of Medicine, Associate Professor, University of
Riverside Community Hospital,
Connecticut School of Medicine,
Department of Emergency Medicine,
Attending Emergency Medicine
Riverside, CA
Physician, Connecticut Children's
Medical Center, Hartford, CT
Melissa Langhan, MD, MHS
Associate Professor of Pediatrics and
Emergency Medicine; Fellowship
Director, Director of Education,
Pediatric Emergency Medicine, Yale
University School of Medicine, New
Haven, CT
Robert Luten, MD
Professor, Pediatrics and
Emergency Medicine, University of
Florida, Jacksonville, FL

David M. Walker, MD, FACEP, FAAP
Director, Pediatric Emergency
Medicine; Associate Director,
Department of Emergency Medicine,
New York-Presbyterian/Queens,
Flushing, NY

International Editor
Lara Zibners, MD, FAAP, FACEP
Honorary Consultant, Paediatric
Emergency Medicine, St. Mary's
Hospital Imperial College Trust,
London, UK; Nonclinical Instructor
of Emergency Medicine, Icahn
School of Medicine at Mount Sinai,
New York, NY

Pharmacology Editor
Aimee Mishler, PharmD, BCPS
Emergency Medicine Pharmacist,
Maricopa Medical Center, Phoenix,
AZ

Quality Editor
Steven Choi, MD
Assistant Vice President, Montefiore
Network Performance Improvement;
Director, Montefiore Institute for
Performance Improvement; Assistant
Professor of Pediatrics, Albert
Einstein College of Medicine, Bronx,
NY

CME Editor
Christopher Strother, MD
Assistant Professor, Emergency
Deborah R. Liu, MD
Medicine, Pediatrics, and Medical
Assistant Professor of Pediatrics,
Education; Director, Undergraduate
Keck School of Medicine of USC;
and Emergency Department
Division of Emergency Medicine,
Simulation; Icahn School of Medicine
Children's Hospital Los Angeles,
at Mount Sinai, New York, NY
Los Angeles, CA

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