Acute Kidney Injury (AKI) by Alex Argyropoulos
this month: risk, recognition and management. Surgical update on hernias, the difficulties of wearing masks for people who stutter and a helping hand from Harry the Hound for children worried about going back to school after covid.
Please do leave comments below.
More on the coca-cola urine story
this month, NF type I, cerebellar ataxia and restless legs syndrome. Do leave comments below.
Possible causes of macrocephaly
this month. Also the start of a new series on causes of coca-cola coloured urine and updates on safeguarding CPD requirements and the terminology of children “in care”. Do leave comments below:
STIs, sexual abuse, eating disorder and haemolytic uraemic syndrome this month. Do leave comments below:
With thanks to Dr David Gardiner, one of our current paediatric FY2 doctors at Homerton University Hospital, for updating us on HUS.
News story in 1999
News story from 2018. Less than 3% of patients die of HUS but 20-30% experience adverse renal outcomes. Think about it in children with bloody diarrhoea and, often, no fever.
Profuse diarrhoea that typically turns bloody after 1-3 days Abdominal pain (crampy) Vomiting Fever (sometimes) Oedema Reduced urine output (abrupt onset) but also polyuria/normal urine output (rarer) Neurological complications: seizure, coma, cranial nerve palsies, confusion, hallucinations Classic triad – anaemia, uraemia and thrombocytopaenia Most common in children under the age of 5
B/P – hypertension Blood film: Fragmentation and signs of haemolysis (Coombs test negative) Raised WCC and neutrophils, low platelets, low Hb Raised LDH Clotting screen typically normal (cf DIC) Raised bilirubin, low albumin Urea and creatinine raised Stool for PCR E.Coli
Refer to secondary care urgently Strict input/output fluid monitoring Correction of anaemia Correction of electrolyte imbalances Antihypertensive therapy if required Dialysis Furosemide to induce diuresis Report to PHE – can’t go back to school until 2 negative stool samples
Kidney Research website on HUS