Pediatric Nephrology in the ICU Stefan G. Kiessling • Jens Goebel Michael J.G. Somers Editors Pediatric Nephrology in the ICU 123 Stefan G. Kiessling, MD Jens Goebel, MD Division of Pediatric Nephrology Nephrology and Hypertension Division and Renal Transplantation Medical Director, Kidney Transplantation Kentucky Children’s Hospital Cincinnati Children’s Hospital Medical Center University of Kentucky 3333 Burnet Avenue 740 South Limestone Street Room J460 Cincinnati, OH 45229-3039, USA Lexington, KY 40536, USA [email protected] [email protected] Michael J.G. Somers, MD Harvard Medical School Children’s Hospital Boston Division of Nephrology 300 Longwood Avenue Boston MA 02115, USA [email protected] ISBN 978-3-540-74423-8 e-ISBN 978-3-540-74425-2 DOI: 10.1007/978-3-540-74425-2 Library of Congress Control Number: 2008928719 © 2009 Springer-Verlag Berlin Heidelberg This work is subject to copyright. 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In every individual case the user must check such information by consulting the relevant literature. Cover design: eStudio Calamar, Spain Printed on acid-free paper 9 8 7 6 5 4 3 2 1 springer.com To our families and our mentors S.K. and J.G. would also like to dedicate this book to the memory of Dr. Heinrich A. Werner, their late colleague, friend and role model with whom they spent so many hours in the PICU. Heinrich, we miss you greatly. Preface The responsibilities of the Pediatric Nephrologist in the Nephrologist and other involved specialists is vital to critical care setting are multifaceted. Management of optimize the outcome for each individual child. acute renal failure with and without renal replacement In this first edition of the book, we have included therapy, fluid and electrolyte abnormalities and hyper- chapters focused on general topics in pediatric nephrol- tensive emergencies are only some of the major clinical ogy that are most germane to the care of the critically circumstances where the renal specialist is involved in ill child. We have tried to look at the clinical situations the care of children admitted to the Pediatric Intensive from the aspect of both the Pediatric Intensivist and Care Unit. Due to the complex and specialized care renal specialist. We hope that this book will supply the required, critical care nephrology could even be consid- medical providers with a framework to approach the ered a separate entity compared to the clinical scenar- challenges faced in practicing Pediatric Intensive Care ios treated in the outpatient setting or on the inpatient Nephrology. pediatric ward. Recently, the changing role of the We express our thanks to all the contributing Nephrologist in the ICU setting, much more expanded authors, all of whom have expertise in either Critical than the classic provision of renal replacement therapy, Care Pediatrics or Pediatric Nephrology and have has been discussed in the community of providers years of experience with the care of this unique patient involved in renal care, and fellowships with special population. Any task as complex as the completion emphasis on Intensive Care Pediatric Nephrology are of a book publication requires several sets of helping being considered. This changing role requires coor- hands in the background. We especially appreciate the dination of care between the Pediatric Nephrologist constant help of Jodi Boyd and Jan Wilkins, as this and other teams of physicians caring for critically ill project would not have been possible without them. children more often than in the past. As several providers are involved in the majority of critically ill children and many valid approaches may Lexington, USA Stefan G. Kiessling exist, consensus needs to be reached before making Cincinnati, USA Jens Goebel important diagnostic or therapeutic decisions. Good Boston, USA Michael J.G. Somers on-going communication between the Intensivist, the June 2008 Contents 1 Disorders of Salt and 12 Hypertension in the Pediatric Water Balance .............................................. 1 Intensive Care Unit ...................................... 171 M. Khurana A.Z. Traum and M.J.G. Somers 2 Disorders of the Acid–Base Status .............. 19 13 Acute Glomerulonephritis .......................... 183 E. Al-Khadra J. Dötsch 3 Dyskalemias .................................................. 35 E.H. Mack and L.R. Shoemaker 14 Acute Interstitial Nephritis ......................... 193 V.R. Dharnidharka, C. Araya, 4 Disorders of Calcium and Phosphate and D. Henry Regulation .................................................... 55 Raymond Quigley 15 The Tumor Lysis Syndrome: An Oncologic and Metabolic Emergency ........ 201 5 Abnormalities in Magnesium J. D’Orazio Metabolism ................................................... 69 D. Samsonov 16 Hemolytic Uremic Syndrome ...................... 219 6 Acute Kidney Injury: S.G. Kiessling and P. Bernard General Aspects ............................................ 85 M. Zappitelli and S.L. Goldstein 17 Vasculitis ....................................................... 231 James A. Listman and Scott Schurman 7 Pharmacotherapy in the Critically Ill Child with Acute Kidney Injury ................. 99 18 Renal Issues in Organ Transplant M.T. Bigham, T.K. Hutson, Recipients in the PICU ................................ 247 and D.S. Wheeler J. Goebel 8 Renal Replacement Therapy in the ICU ..................................................... 115 19 Acute Kidney Injury Following K.E. Luckritz and J.M. Symons Cardiopulmonary Bypass ........................... 261 D.S. Wheeler, C.L. Dent, P. Devarajan, 9 Nutrition for the Critically Ill Pediatric and N.W. Kooy Patient with Renal Dysfunction .................. 127 N.M. Rodig 20 Contrast-Induced Nephropathy ................. 275 10 Tools for the Diagnosis of V.M. Kriss and S.G. Kiessling Renal Disease ............................................... 139 K. Mistry and J.T. Herrin 21 Intoxications ................................................. 281 P. Bernard 11 Urosepsis ....................................................... 163 G. Abuazza and C. Nelson Subject Index ...................................................... 291 List of Contributors Ghazala Abuazza Prasad Devarajan Division of Pediatric Nephrology University of Cincinnati College of Medicine University of Kentucky Children’s Hospital Cincinnati Children’s Hospital Medical Center 740 South Limestone Street 3333 Burnet Avenue Lexington, KY 40536, USA Cincinnati, OH 45229-3039, USA Erman Al-Khadra Vikas R. Dharnidharka Cincinnati Children’s Hospital Medical Center University of Florida College of Medicine Critical Care Division of Pediatric Nephrology 3333 Burnet Avenue P.O. Box 100296, 1600 SW Archer Road Cincinnati, OH 45229-3039, USA Gainesville, FL 32610-0296, USA [email protected] Carlos Araya University of Florida, College of Medicine Division of Pediatric Nephrology John D’Orazio P.O. Box 100296, 1600 SW Archer Road Division of Hematology-Oncology Gainesville, FL 32610-0296, USA University of Kentucky College of Medicine Markey Cancer Center Philip Bernard Combs Research Building Room 204 Division of Pediatric Critical Care 800 Rose Street Kentucky Children’s Hospital Lexington, KY 40536-0096, USA University of Kentucky [email protected] 800 Rose Street Lexington, KY 40536, USA Jörg Dötsch [email protected] Kinder- und Jugendklinik Universitätsklinikum Erlangen Michael T. Bigham Loschgestr 15 Critical Care Medicine 91054 Erlangen, Germany Akron Children’s Hospital [email protected] One Perkins Square Akron, OH 44308, USA [email protected] Jens Goebel Nephrology and Hypertension Division Catherine L. Dent Medical Director, Kidney Transplantation Division of Cardiology Cincinnati Children’s Hospital Medical Center Cincinnati Children’s Hospital Medical Center 3333 Burnet Avenue 3333 Burnet Avenue Cincinnati, OH 45229-3039, USA Cincinnati, OH 45229-3039, USA [email protected] xii List of Contributors Stuart L. Goldstein Neil W. Kooy Texas Children’s Hospital Division of Pediatric Critical Care Medicine 6621 Fannin Street, MC-3-2482 University of Minnesota School of Medicine Houston, TX, 77030, USA University of Minnesota Children’s Hospital Fairview, 420 Delaware St. SE Minneapolis, MN 55455, USA Dwayne Henry University of Florida, College of Medicine Vesna M. Kriss Division of Pediatric Nephrology Department of Radiology and Pediatrics P.O. Box 100296, 1600 SW Archer Road University of Kentucky Gainesville, FL 32610-0296, USA and Kentucky Children’s Hospital Lexington, KY 40536, USA John T. Herrin [email protected] Division of Nephrology