Page 82 - Proceeding of Plenary Abstract of Parallel Symposim

NEFROLOGI

Acute Kidney Injury in Critical Ill Children

Ina Zarlina
Department of Child Health, Harapan Kita Women and Children Hospital, Jakarta, Indonesia

Abstract
Background Acute kidney injury (AKI) is characterized by rapid decline in renal function with accumulation
of nitrogenous waste and inability of kidney to maintain fluid and electrolyte homeostasis. AKI is common,
affecting children admitted to Intensive Care Unit (ICU) and is associated with poor outcomes including
increased mortality and morbidity among critically ill children. AKI is heterogenous syndrome that involves
multiple pathophysiological pathways for tissue injury. Objective To overview impact and management of
acute kidney injury in critical ill children. Methods Literature reviews. Results Prevention and early detection
are the mainstay of treatment. Optimization of volume status, control of blood pressure and nutritional
management have shown effectiveness in preventing the occurrence of AKI. Renal replacement therapy is
needed when conservative management fails. Conclusion Acute kidney injury is common in critical care but
early detection and appropriate management decreased mortality and morbidity.
Keywords: acute kidney injury; critical care; children

Hypertensive Encephalopaty in Children

Muhammad Riza Kurniawan
Department of Child Health Faculty of Medicine Universitas Airlangga, Dr Soetomo General Academic Hospital, Surabaya

Abstract
Background Hypertension called the silent killer, about 20-30% of adults have hypertension. Previous studies
shown that elevated blood pressure in childhood increases the risk for adult hypertension. The prevalence of
hypertension in children and adolescents is 3.5%, hypertension is greater in boys than in girls. Hypertension
prevalence increase in youth with overweight and obesity. In 70-80% of cases hypertension is caused by
renal diseases. Discussion Severe hypertension or hypertensive crisis defined as a rise in blood pressure >30
mmHg above 95th percentile. Hypertensive crisis is a critical condition which contribute to morbidity and
mortality in pediatric population. Hypertensive urgency is acute elevation of blood pressure without end
organ damage and usually accompanied with minor symptoms. Hypertensive emergency is life threatening
condition, the form of hypertensive crisis with end organ damage with more severe symptoms, mainly
neurological, renal, and cardiac. Hypertensive encephalopathy is hypertensive emergency with neurological
manifestation. Hypertensive encephalopathy defined as acute brain dysfunction induced by sustained severe
hypertension. The brain is fail to maintain the autoregulatory system in cerebral perfusion and its manifest as
delirium, lethargy, confusion, severe headache, and seizure. Hypertensive encephalopathy requires immediate
evaluation from anamnesis, physical examination, laboratory and radiology examination. Management of
hypertensive encephalopathy range from fast acting intra venous medication to oral medication for less severe
case. Emergency blood pressure reduction with intensive monitoring are needed to prevent complications and
permanent organ damage.
Keywords: hypertension, hypertensive emergency, hypertensive encephalopathy in children

Kongres Nasional Ilmu Kesehatan Anak XVIII 67