Ignite Creation Date:
2024-10-26 @ 3:41 PM
Last Modification Date:
2024-10-26 @ 3:41 PM
Study NCT ID:
NCT06612073
Status:
NOT_YET_RECRUITING
Last Update Posted:
None
First Post:
2024-09-21
Brief Title:
Evaluation Of The Degree Of Kidney Injury in Children With Hypovolemic Shock
Sponsor:
None
Organization:
None
Study Overview
Official Title:
Evaluation Of The Degree Of Kidney Injury in Children With Hypovolemic Shock
Status:
NOT_YET_RECRUITING
Status Verified Date:
2024-09
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
No
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
To evaluate renal affection and its degree in hypovolemic shocked
children
children
Detailed Description:
Acute kidney injury is a syndrome characterised by the rapid loss of the kidneys excretory function and is typically diagnosed by the accumulation of end products of nitrogen metabolism urea and creatinine or decreased urine output or both It is the clinical manifestation of several disorders that affect the kidney acutely Acute kidney injury is common in hospital patients and very common in critically ill patients In these patients it is most often secondary to extrarenal events In low-income and middle-income countries infections and hypovolaemic shock are the predominant causes of AKI In high-income countries AKI mostly occurs in elderly patients who are in hospital and is related to sepsis drugs or invasive procedures Infection and trauma-related AKI and AKD are frequent in all regions
There are numerous potential causes of AKI mainly related to a focal mismatch between oxygen and nutrient delivery because of impaired microcirculation to the nephrons and increased energy demands due to cellular stress
The prerenal form of AKI is due to any cause of reduced blood flow to the kidney This may be part of systemic hypoperfusion resulting from hypovolemia or due to selective hypoperfusion of the kidneys such as
Hypovolemia hemorrhage severe burns and gastrointestinal fluid losses such as diarrhea vomiting and high ostomy output
Hypotension from systemic vasodilation septic shock anaphylaxis anesthesia administration
Glomerular efferent arteriolar vasodilation causing intraglomerular hypotension ACE inhibitors angiotensin receptor blockers
Diagnosis
Increase in serum creatinine by 03 mgdL or more 265 μmolL or more within 48 hours And other diagnostic criteria according to the stage Shock is the state of insufficient blood flow to the tissues of the body as a result of problems with the circulatory system56Initial symptoms of shock may include weakness fast heart rate fast breathing sweating anxiety and increased thirst Shock is divided into four main types based on the underlying cause hypovolemic cardiogenic obstructive and distributive shockHypovolemic shock also known as low volume shock may be from bleeding diarrhea or vomiting
One of most common complication of shock is acute kidney injury due to decrease perfusion to kidney which can improved once shock improved
Management
Aggressive intravenous fluids are recommended in most types of shock eg 1-2 liter normal saline bolus over 10 minutes or 20 mLkg in a child which is usually instituted as the person is being further evaluated7 Colloids and crystalloids appear to be equally effective with respect to outcomes8 Balanced crystalloids and normal saline also appear to be equally effective in critically ill patients9 If the person remains in shock after initial resuscitation packed red blood cells should be administered to keep the hemoglobin greater than 100 gL
Some AKI patients tend to develop volume overload which should be corrected as early as possible to avoid pulmonary and cardiac complications Euvolemic state can be achieved with the help of diuretics which is a cornerstone in managing such patients Usually high doses of IV furosemide are needed to correct volume overload in AKI patients however it plays no role in converting oliguric AKI to non-oliguric AKI
In some cases short-term renal replacement therapy is needed for AKI until the kidney function recovers Some indications for RRT are severe and non-responsive hyperkalaemia uremic pericarditis and pulmonary oedema where the patient is prone to develop multiple electrolyte and acid-base abnormalities as well as fluid overload
Dialysis in this setting is usually performed through a temporary venous catheter when required Continuous renal replacement therapy can also be utilized in patients who cannot tolerate haemodialysis due to hypotension It is a much slower continuous type of dialysis Metabolic acidosis is one such instance where systemic administration of citrate or bicarbonate is often required to maintain a suitable blood pH The requirement for renal replacement therapy should be re-evaluated daily Renal replacement therapy is usually required for short periods ranging from a few days to a few weeks however some cases can take months to recover and may require intermittent RRT support
There are numerous potential causes of AKI mainly related to a focal mismatch between oxygen and nutrient delivery because of impaired microcirculation to the nephrons and increased energy demands due to cellular stress
The prerenal form of AKI is due to any cause of reduced blood flow to the kidney This may be part of systemic hypoperfusion resulting from hypovolemia or due to selective hypoperfusion of the kidneys such as
Hypovolemia hemorrhage severe burns and gastrointestinal fluid losses such as diarrhea vomiting and high ostomy output
Hypotension from systemic vasodilation septic shock anaphylaxis anesthesia administration
Glomerular efferent arteriolar vasodilation causing intraglomerular hypotension ACE inhibitors angiotensin receptor blockers
Diagnosis
Increase in serum creatinine by 03 mgdL or more 265 μmolL or more within 48 hours And other diagnostic criteria according to the stage Shock is the state of insufficient blood flow to the tissues of the body as a result of problems with the circulatory system56Initial symptoms of shock may include weakness fast heart rate fast breathing sweating anxiety and increased thirst Shock is divided into four main types based on the underlying cause hypovolemic cardiogenic obstructive and distributive shockHypovolemic shock also known as low volume shock may be from bleeding diarrhea or vomiting
One of most common complication of shock is acute kidney injury due to decrease perfusion to kidney which can improved once shock improved
Management
Aggressive intravenous fluids are recommended in most types of shock eg 1-2 liter normal saline bolus over 10 minutes or 20 mLkg in a child which is usually instituted as the person is being further evaluated7 Colloids and crystalloids appear to be equally effective with respect to outcomes8 Balanced crystalloids and normal saline also appear to be equally effective in critically ill patients9 If the person remains in shock after initial resuscitation packed red blood cells should be administered to keep the hemoglobin greater than 100 gL
Some AKI patients tend to develop volume overload which should be corrected as early as possible to avoid pulmonary and cardiac complications Euvolemic state can be achieved with the help of diuretics which is a cornerstone in managing such patients Usually high doses of IV furosemide are needed to correct volume overload in AKI patients however it plays no role in converting oliguric AKI to non-oliguric AKI
In some cases short-term renal replacement therapy is needed for AKI until the kidney function recovers Some indications for RRT are severe and non-responsive hyperkalaemia uremic pericarditis and pulmonary oedema where the patient is prone to develop multiple electrolyte and acid-base abnormalities as well as fluid overload
Dialysis in this setting is usually performed through a temporary venous catheter when required Continuous renal replacement therapy can also be utilized in patients who cannot tolerate haemodialysis due to hypotension It is a much slower continuous type of dialysis Metabolic acidosis is one such instance where systemic administration of citrate or bicarbonate is often required to maintain a suitable blood pH The requirement for renal replacement therapy should be re-evaluated daily Renal replacement therapy is usually required for short periods ranging from a few days to a few weeks however some cases can take months to recover and may require intermittent RRT support
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None