A presentation given at the VIPCo conference. Recorded presentation can be seen in this YouTube link: https://youtu.be/mSpZl-JtiIA

1. Acute Renal Failure
This is What Pediatric Nephrologists Do
Ibrahim Sandokji, MD, FAAP
Pediatric Nephrology Consultant
Assistant Professor
Taibah University
Madinah, Saudi Arabia

2. Acute Renal Failure
This is What Pediatric Nephrologists Do
Ibrahim Sandokji, MD, FAAP
Pediatric Nephrology Consultant
Assistant Professor
Taibah University
Madinah, Saudi Arabia

3. AKI
Management Prevention
Definition
Work up
Epidemiology

4. Epidemiology

5. Is AKI bad?
Death
>10 times higher
inpatient mortality
11% with AKI
0.9% without AKI
P < 0.01
Long-term
CKD
In 17%-20%
HTN
In 22%-30%
Sandokji et al. The Journal of the
American Society of Nephrology. 2020
Within 4 years after AKI
Zappitelli et al. Clinical Journal of the
American Society of Nephrology. 2020

6. Definition

7. KDIGO Diagnostic Criteria
Kidney Disease Improving Global Outcomes (KDIGO). 2012

8. Creatinine
Inaccurate
Dietary protein intake Neonatal creatinine
?maternal creatinine
Delayed
Can take days to peak
after injury
Does not increase until
substantial injury &
nephron loss
In children
Maturation
in first 2 years of life
Sandokji & Greenberg.
Current Opinion in Pediatrics. 2020
Sandokji & Greenberg.
Seminars in Nephrology. 2021
Affected by muscle mass

9. Novel Biomarkers
Sandokji & Greenberg. Current Opinion in Pediatrics. 2020

10. Work up

11. Prerenal azotemia is
usually rapidly reversed
by restoration of renal
perfusion
1. History
2. Examination
3. Electrolytes &
blood gas
4. Urinalysis & UPC
5. Renal ultrasound

12. Management

13. AKI Management
Kidney Disease Improving Global Outcomes (KDIGO). 2012

14. Supportive Management
Treat the underlying cause
Fluid management
 Hypovolemia –> fluid resuscitation
 Euvolemia –> balanced I/O
 Hypervolemia -> fluid restriction
Management of complications
 Electrolyte disturbances
 Metabolic acidosis
 Hypertension
Adequate nutrition
Drug management
 Avoidance of nephrotoxic agents
 Dosing adjustment

15. Indications for Acute Dialysis

16. Prevention

17. Renal Angina Index
Basu et al. Kidney Int. 2014

18. Sodium
bicarb given
Glucose = 132
Loop diuretic given
RBC transfusion
Glucose = 134
Glucose = 120
Creatinine = 0.7
Real-time
Alert
Creatinine-based
AKI definition
0.6 → 1.1
Glucose = 112
Sandokji et al. The Journal of the
American Society of Nephrology.
2020
AKI Prediction

19. Nephrotoxic Injury Negated by Just-in-time Action (NINJA)
Automated system using EHR data
in patients with 3+ nephrotoxic
medications or 3+ days of IV
aminoglycoside exposure
Goldstein et al. Kidney Int. 2016

20. Nephrotoxic Injury
Negated by Just-in-
time Action (NINJA)
AKI rates decreased by 64%
(from 2.96 to 1.06 patients
with AKI/1000 patient days)
Goldstein et al. Kidney Int. 2016

21. Summary

22. Injury not
failure
Azotemia
(MCC) is
reversible
Promising
novel
biomarkers
Early
recognition
→ improve
outcome
Simple Rx
approach:
Pre
Renal
Post
High
mortality
Dx
Creatinine
(limited &
delayed) Not all AKI
treated
with fluids
Long-term
complications
(CKD)
Acute
complications
?RRT

23. Save kidneys
Save lives
Ibrahim Sandokji, MD
isandokji@taibahu.edu.sa
isandokji@gmail.com
+966 50 632 5770
@sandokji