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Acute Kidney Injury (AKI)

Summary

Acute kidney injury (AKI) is a sudden decline in kidney function that affects the body’s ability to filter waste and balance fluids and electrolytes. It is often caused by:

  • Infections (sepsis), dehydration, or low blood pressure (pre-renal AKI)
  • Medications toxic to the kidneys, such as some antibiotics (e.g., gentamicin) or pain relievers (NSAIDs) (intrinsic AKI)
  • Blockages in the urinary tract that prevent urine from leaving the body (post-renal AKI)

AKI is often detected during routine blood tests rather than through specific kidney-related symptoms. However, children may show signs such as low urine output, swelling, tiredness, confusion, or difficulty breathing. 

Diagnosis and When to Seek Help

AKI is diagnosed based on:

  • A sudden increase in blood creatinine levels (a marker of kidney function)
  • A significant drop in urine output
  • Symptoms of fluid overload, such as swelling (edema) or difficulty breathing

Seek medical attention if your child has:

  • Severe vomiting or diarrhea leading to dehydration
  • A prolonged illness with fever and low urine output
  • Swelling in the legs, face, or abdomen
  • Difficulty breathing or confusion

Management

  • Treat the underlying cause: Address infections, dehydration, or medication side effects.
  • Correct fluid and electrolyte imbalances: Some children need IV fluids or medications to restore balance.
  • Avoid harmful medications: If AKI is caused by a drug, it may need to be discontinued.
  • Relieve urinary blockages: If a blockage is present, a catheter or surgery may be needed.
  • Dialysis: In severe cases where kidney function does not improve, temporary dialysis may be required to remove toxins from the blood. 

Follow-Up and Monitoring

  • Regular kidney function tests: To monitor recovery and prevent long-term damage.
  • Long-term kidney health checks: Children who have had AKI are at higher risk of developing chronic kidney disease (CKD) later in life.
  • Preventive care: Encourage good hydration and avoid medications that may harm the kidneys.

Early detection and proper management are crucial to prevent complications and support full kidney recovery.

History and Exam

Key diagnostic factor

  • hypotension
  • risk factors
  • kidney insults
  • reduced urine production

Other diagnostic factors

  • dizziness and orthostatic symptoms
  • hypertension
  • altered mental status
  • pericardial/pleural rub

Risk factors

  • advanced age
  • underlying kidney disease
  • diabetes mellitus
  • sepsis

Diagnostic Investigations

1st investigations to order

  • basic metabolic profile (including urea and creatinine and liver function tests)
  • serum potassium
  • FBC
  • bicarbonate

Investigations to consider

  • renal tract ultrasound
  • abdominal CT or MRI scan
  • nuclear renal flow scan
  • urine osmolality

Emerging tests

  • novel serum and urinary biomarkers

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      Social and emotional functioning refers to a child’s ability to understand, express, and manage their emotions, as well as to interact effectively with others. These skills are fundamental for building positive relationships, developing empathy, and coping with the everyday challenges of growing up.

      Children who experience difficulties in social and emotional functioning may struggle with recognizing their own feelings or those of others, regulating emotional responses, or responding appropriately in social situations. This can lead to challenges such as anxiety, low self-esteem, difficulty making friends, or misunderstandings with peers and adults.

      In the school environment, social and emotional difficulties can impact a child’s engagement, cooperation, and overall learning experience. Emotional distress may manifest as withdrawal, irritability, or disruptive behaviour, which can further affect academic progress and peer relationships.

      Assessment of social and emotional functioning as part of a neuropsychological evaluation typically includes behavioural observations, standardized rating scales, and information gathered from parents, teachers, and sometimes the child. This comprehensive approach helps identify strengths and areas for support in emotional regulation, social skills, and adaptive behaviours.

      Understanding a child’s social-emotional profile allows for the development of tailored strategies to enhance emotional wellbeing, build resilience, and improve social communication. Early intervention and supportive environments can empower children to navigate their emotions more effectively, fostering confidence and meaningful connections. 

      At Offspring Health, we aim to provide transparent information about the costs involved in neurodevelopmental and educational assessments.

      Neuropsychological assessments typically involve multiple sessions that usually take between 8 and 16 hours in total, depending on the complexity and individual needs. Our hourly rate is $260, so the total cost typically ranges between $2,300 and $4,230.

      Fees generally cover:

      • Initial consultation and history gathering
      • Testing sessions where your child will complete various fun and interactive tasks
      • Liaison with schools or health professionals as needed
      • Comprehensive case analysis and report preparation
      • Feedback sessions with families and, where applicable, educators or other professionals

      Please note that standard neuropsychological assessments are generally not covered by Medicare. However, some assessments and therapy services may be funded through the National Disability Insurance Scheme (NDIS) for eligible participants. We recommend discussing funding options with your NDIS planner or support coordinator prior to booking. Private health insurance may offer partial rebates depending on your level of coverage.

      What’s the next step?

      Please phone reception for a discussion about your needs or email psychology@offspringhealth.com