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Related Concept Videos

Acute Kidney Injury I: Introduction01:22

Acute Kidney Injury I: Introduction

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Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
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Acute Kidney Injury II: Pathophysiology01:29

Acute Kidney Injury II: Pathophysiology

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Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
37
Acute Kidney Injury III: Clinical Manifestations01:29

Acute Kidney Injury III: Clinical Manifestations

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Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
44
Acute Kidney Injury V: Interprofessional Care01:20

Acute Kidney Injury V: Interprofessional Care

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Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
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Acute Kidney Injury VI: Nursing Management01:22

Acute Kidney Injury VI: Nursing Management

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Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
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Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

40
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
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Pediatric Acute-on-Chronic Liver Failure.

Seema Alam1, Bikrant Bihari Lal2

  • 1Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. seema_alam@hotmail.com.

Indian Journal of Pediatrics
|June 22, 2023
PubMed
Summary

Acute-on-chronic liver failure (ACLF) in children involves liver damage superimposed on cirrhosis, leading to inflammation and organ failure. Pediatric ACLF prognosis is often better than in adults due to treatable causes and better reserves.

Keywords:
ACLFLiver transplantation in ACLFOutcome in ACLFPediatric ACLFPediatric acute-on-chronic liver failureTreatment of ACLF

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Area of Science:

  • Pediatric Hepatology
  • Critical Care Medicine
  • Gastroenterology

Background:

  • Acute-on-chronic liver failure (ACLF) is a severe syndrome in patients with cirrhosis, characterized by systemic inflammation, sepsis, and organ failure.
  • Definitions of pediatric ACLF lack consensus, with differing criteria between the Asia Pacific Association for Study of Liver Diseases (APASL) and European Association for Study of Liver Diseases (EASL).
  • Common underlying causes in children include Wilson disease (WD) and autoimmune hepatitis (AIH), with acute viral hepatitis or flares of WD/AIH as precipitating events.

Purpose of the Study:

  • To review the current understanding of pediatric ACLF, including definitions, etiologies, outcomes, and management strategies.
  • To highlight the differences in ACLF definitions between major liver associations and the specific challenges in pediatric cases.
  • To discuss prognostic factors and treatment approaches for pediatric ACLF.

Main Methods:

  • Review of existing literature and guidelines on ACLF, with a focus on pediatric cases.
  • Analysis of reported outcomes, mortality rates, and prognostic scores (e.g., APASL ACLF Research Consortium [AARC] score).
  • Discussion of treatment modalities, including medical management, bridging therapies like plasma exchange, and liver transplantation (LT).

Main Results:

  • Pediatric ACLF outcomes range from 19% to 59% for death or liver transplantation (LT).
  • Prognosis in pediatric ACLF is generally better than in adults due to treatable etiologies, fewer organ failures, and better hepatic reserves.
  • An APASL ACLF Research Consortium (AARC) score >= 11 predicts poor 28-90 day mortality.

Conclusions:

  • Prompt diagnosis and management of underlying causes are crucial for pediatric ACLF treatment.
  • Early initiation of bridging therapies, such as high-volume plasma exchange, can be vital.
  • Liver transplantation should be considered promptly for non-improving cases to prevent sepsis or multi-organ failure.