Approach to status epilepticus pptx in paediatrics

Approach to status epilepticus

1. CASE PRESENTATION Moses Ben Machaka Eden University student Bsc in Clinical medicine

2. Objectives Case presentation AKI Management of AKI CKD Management of CKD Zambia guidelines on AKI & CKD

3. Acute Kidney Injury Definition: This is reversible damage involving all nephrons (glomeruli plus tubules) resulting to loss of glomerular and tubular function It involves 7% of hospitalized patient

4. Causes of AKI Can be categorized into three: Pre-Renal Intral -Renal Post Renal

5. Pre-Renal cause Hypovolaemia - Haemorrhage, Gastrointestinal fluid loss, Diuresis, Burns Decreased cardiac output - Cardiogenic shock, Massive pulmonary embolus, Cardiac tamponade Renovascular obstruction Other causes of hypotension - Sepsis, Vasodilator drugs Interference with autoregulation of renal blood flow i.e ACEIs, Prostaglandin inhibitors ( i.e NSAIDs).

6. INTRA-RENAL Acute tubular necrosis (ischaemic or toxic) Acute glomerulonephritis Intra-renal vasoconstriction (e.g., sepsis) Hypercalcemia Tubular obstruction i.e uric acid crystals Severe hypertension Nephrotoxins Interstitial nephritis

7. Post-renal Bilateral ureteric obstruction Calculi (nephrolithiasis) Tumours Retroperitoneal fibrosis Surgical mishap Urethral obstruction Urethral stricture Neurogenic bladder

8. Clinical Features of AKI Asymptomatic patients Elevated in creatinine levels Abnormal urinalysis Signs and symptoms Oliguria and anuria Edema Hypertension Generalized Body weakness Altered mental status Vomiting Seizures Joints pain fever

9. Staging of AKI AKI staging RIFLE Category Serum creatinine Criteria Urine output 1 Risk Serum creatinine increase 1.5 times < 0.5mL/kg/h in 6 hours 2 Injury Serum creatinine increase 2-3 times baseline < 0.5mL/kg/h in 12 hours 3 Failure Serum creatinine of > than 3 < 0.3mL/kg/h over 24 hours Anuria lasting for 24 hours

10. Complication of AKI Uremia Shock Electrolytes disturbance Metabolic acidosis

11. Treatment of AKI Depends on the Cause Hemodynamic stability Avoid renal insults drugs

12. Indication for Dialysis A E I O U

13. CHRONIC KIDNEY DISEASE Definition: This is the Permanent or irreversible damage to the nephrons impairing renal functionality. Remaining nephrons are intact and retain normal function Blood urea and creatinine are high but unchanging. The key characteristic of well developed CRF is polyuria - the opposite to the oliguria or anuria of ARF.

14. Causes of CKD The most common are: Glomerulonephritis Diabetes Mellitus Hypertension. Pyelonephritis Interstitial nephritis Polycystic kidney disease Nephrotoxic drugs Multisystem disease Hypovolaemia Vomiting, diarrhoea excessive use of diuretics Urinary tract infection Congestive cardiac failure • Drugs Tetracyclines Non-steroidal anti-inflammatory agents Angiotensin-converting-enzyme inhibitors Exacerbation of underlying disease (e.g. systemic lupus erythematosus)

15. Additional causes include congenital nephrotic syndrome prune belly syndrome cortical necrosis focal segmental glomerulosclerosis hemolytic uremic syndrome.

16. Systemic manifestation of CKD

17. Investigations Infection screen LABORATORY BLOOD Full blood count Blood culture ESR Urea and Electrolytes and creatinine URINE Urine M/C/S urinalysis 2. RADIOLOGY KUB Urethrogram

18. Stages of chronic disease(CKD) Stage DESCRIPTION GFR (mL/min/1.73 m 2 ) Stage 1 Kidney damage with normal or increased GFR >90 Stage 2 Kidney damage with mild decrease in GFR 60–89 Stage 3 Moderate decrease in GFR 30–59 Stage 4 Severe decrease in GFR 5–29 Stage 5 Kidney failure <15 or on dialysis

19. Management of CKD Encourage oral Water intake Careful control of Na+, K+, phosphate and protein intake. Treatment of anaemia with erythropoietin hypocalcaemia with Vitamin D. Oral bicarbonate if acidosis is severe In end-stage CRF Dialysis - hemodialysis or peritoneal dialysis, Renal transplantation

20. Reference Robbins and kumar Basic pathology 11 th edi , elsevir Nelson essential of pediatrics