Lal et al identified risk factors for acute kidney injury in a pediatric patient with acute-on-chronic liver failure (ACLF). The authors are from the Institute of LIver and Biliary Sciences in New Delhi, India.
Patient selection: pediatric patient (1 to 18 years) with acute-on-chronic liver failure (ACLF)
Outcome: acute kidney injury (KDIGO criteria: increase serum creatinine by >=0.3 mg/dL; serum creatinine 1.5 times baseline; urine output < 0.5 mL per kg per hour for > 6 hours)
Causes of acute kidney injury:
(1) hepatorenal syndrome
(2) sepsis
(3) nephrotoxic drugs
(4) dehydration
(5) bile pigment related acute tubular necrosis
Predictors of acute kidney injury:
(1) serum total bilirubin > 17.7 mg/dL
(2) presence of SIRS (systemic inflammatory response syndrome)
Development of acute kidney injury in a pediatric patient with ACLF is associated with a poor outcome so aggressive management can be life-saving.
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