Pediatric emergency medicine trisk 2885 2885
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insults to the renal vasculature, glomeruli, or interstitium. Causes of
postrenal AKI include congenital or acquired anatomic obstructions of the
urinary tract such as posterior urethral valves, stones, masses, and
functional or anatomic bladder outlet obstruction.
TABLE 100.13
ESTIMATION OF GLOMERULAR FILTRATION RATE BY THE
SCHWARTZ FORMULA
C cr = k × L/S cr
C cr = creatinine clearance in mL/min/1.73 m2
k a = proportionality constant
L = length (cm)
S cr = serum creatinine (mg/dL)
ak
values:
Low–birth-weight infants during the first year of life = 0.33
Full-term babies during first year of life = 0.45
Children and adolescent girls = 0.55
Adolescent boys = 0.7
Adapted from Schwartz GJ, Feld LG, Langford DJ. A simple estimate of glomerular filtration rate in
full-term infants during the first year of life. J Pediatr 1984;104:849–854; Schwartz GJ, Gauthier B.
A simple estimate of glomerular filtration rate in adolescent boys. J Pediatr 1985;106:522–526; and
Schwartz GJ, Haycock GB, Edelmann CM Jr, et al. A simple estimate of glomerular filtration rate in
children derived from body length and plasma creatinine. Pediatrics 1976;58:259–263.
Goals of Treatment
The goals of treatment include mitigating and/or correcting any fluid or
electrolyte disturbances resulting from AKI as well as removing the
underlying cause, if possible. Measures should be taken to induce
nitrogenous waste elimination and achieve electrolyte homeostasis whether
by the kidneys themselves or through RRT when needed.
Clinical Considerations
Clinical recognition. Children with AKI may present with a variety of
complaints related either directly to kidney dysfunction or to the underlying
cause itself. Patients and caregivers may notice changes in the urine output
or quality. They may present with concern for changes in appearance or
