About your child’s care with AKI
- Your child will probably need to stay in a hospital for a few days or longer while his or her kidneys get better.
- Many children will not need special treatment, but will be monitored to make sure they have the right amount of water and salts in their body.
- Your child may need to make temporary changes to what they eat and drink, and may need a feeding device to make sure they get the nutrients they need.
- Some children get AKI because of problems with their immune system, which normally protects their body from disease or infection. They may need special medicines or treatment to stop the immune system from harming their kidneys.
- Some children get AKI because of a blockage that affects how they pass urine. They may need a urinary catheter to drain urine from their bladder, or an operation.
- Some children need medicines to treat complications – such as swelling in their body and high blood pressure (hypertension).
- Children with AKI develop reduced kidney function. In most cases this does not need any special treatment, but a very small number will need further specialist treatment, such as dialysis.
It is important that your child follows any treatment plan outlined by your doctor.
Questions you may wish to ask your child's medical team
- What treatment does my child need?
- How will the treatment help my child?
- How long will my child be in hospital?
- How can I help my child prepare for procedures and treatments?
- If the first treatment does not work in my child, what happens next?
- How will I know if we need to go back to the hospital or see the doctor?
- Will the AKI come back? How will I know?
Where will my child be treated for AKI?
Your child will probably be in a paediatric unit. This is an area of a hospital that treats babies, children and young people with different health conditions.
Some children are referred to a paediatric renal unit, a special unit for children with kidney problems, which may be in a different hospital to your own. Some are treated in a paediatric intensive care unit (PICU), which specialises in treating acute and serious illness.
A team of healthcare professionals will look after your child.
Your child can go home when the doctor thinks that his or her health is stable. Often, your child will need to visit the hospital during the day – as an outpatient – for more treatment.
No special treatment
Sometimes the kidneys can heal themselves over a few days or weeks – especially if the AKI is not severe and there are no other complications, such as infection.
Your child’s healthcare team will make sure your child has the right amount of water and salts in the body while his/her kidneys get better. They may also need to stop any medicines that your child is taking that could be harming his or her kidneys.
Changes to eating and drinking
Your child may need to make temporary changes to what they eat – for example, less salt and less of certain foods. Your child may also need to drink less fluid, such as water, squash and soft drinks.
The food we eat gives us nutrients, which we need to grow and stay healthy. Some children with AKI do not get enough nutrients or calories, and need to take nutritional supplements, which may be available as tablets, capsules or liquid.
Your doctor, nurse or a paediatric dietitian will help you and your child make these changes.
Feeding devices
If your child is unable to eat and drink all he or she needs for his or her growth and development, he or she may need a feeding device. All or some of the nutrition he or she needs, and water and medicines if needed, can be given through a tube or button. Read more about types of feeding devices.
Suppressing the immune system
Some types of AKI are caused by a problem with the immune system, which normally protects the body against disease and infection. Steroids and other immunosupressants are medicines that suppress the immune system – they stop it from fully working, so that it stops attacking the body. They are usually taken by mouth, such as tablets, capsules or liquid medicine. Your doctor will work out the amount of medicine (the dose) that is right for your child. The dose will be shown on the medicine label.
It is important that you follow your doctor’s instructions about when and how much to give. Continue to give the medicine to your child as your doctor has told you, even if he or she is getting better.
Plasma exchange
If your child’s kidney function is getting worse in spite of the usual treatments, he or she may need a procedure called plasma exchange, which is also called plasmapheresis.
Antibodies are proteins that are part of the immune system, and in some types of AKI some antibodies are harming the kidneys. Plasma exchange removes antibodies from the blood.
If your child’s kidney function is getting worse in spite of the usual treatments, they may need a procedure called plasma exchange or plasmapheresis. Antibodies are proteins that are part of the immune system, and in some types of AKI, they are harming the kidneys. This procedure removes antibodies from the blood.
Plasma exchange
Plasma is the liquid or watery part of blood. It help carry blood cells, protein and other substances around the body. Plasma exchange is a procedure that removes antibodies that are harming your child’s kidneys from his or her blood. It removes the blood from the body, separates the plasma and harmful antibodies and returns the blood, with a plasma substitute, to the body.
- Each plasma exchange takes about 2-3 hours and is done in hospital. Children will usually need more than one exchange.
- A catheter, which is a large tube, is inserted into one of the large veins in the chest or neck. Your child’s blood is taken from his or her body through the catheter.
- Using special equipment, your child’s blood is separated into two parts: their plasma and some substances, including the harmful antibodies; and their blood cells.
- Your child’s blood cells are added to a plasma substitute – either plasma or a protein called albumin from a donor, another person who has donated blood.
- This is returned to your child’s body through the catheter.
- As blood is taken from your child and returned to him or her at the same rate, only a small amount of blood is outside his or her body at any time.
Your child’s doctor or nurse will give you more information about plasma exchange and how you and your child can prepare for it.
Treating blockage
Many children with post-renal AKI have an obstruction, or blockage, in their urinary system.
There are different ways that these can be treated. Your doctor will explain what will happen and how to prepare for it.
Urinary catheterisation
A procedure called urinary catheterisation drains urine from the bladder. This is done using a catheter, a thin, flexible tube. There are two types of urinary catheters:
- urethral catheter – placed through the urethra
- suprapubic catheter – inserted through the tummy skin, using a needle
The kidneys usually recover a few weeks after urinary catheterisation.
Urinary catheterisation
Your nurse or doctor cleans your child’s genital area, wearing sterile gloves.
A small catheter is passed through your child’s urethra and into his or her bladder. This may feel a little uncomfortable but should not hurt.
Urine passes through the catheter straight away and is collected in a sterile (completely clean) container.
Suprapubic catheter
Your child probably has a general anaesthetic, a medicine that helps him or her go to sleep so they do not feel pain.
- A needle is inserted through the tummy’s skin into the bladder.
- A catheter is passed down the needle so that one end is in his or her bladder. The needle is removed, leaving the tube in place.
- Urine passes through the catheter and is collected in a sterile container.
- The needle is placed above the genitals – “supra” means above and “pubic” means the genital area.
Surgery
If your child has a more complicated blockage, they may need to have an operation, or surgery.
Your doctor will explain what will happen and how to prepare for it. The kidneys usually improve a few weeks after surgery. Occasionally, there is an infection, which will be treated, but may delay your child’s recovery. Your doctor will give you more information.
Treating complications
Controlling blood pressure
Children with AKI may have high blood pressure, or hypertension. Their blood pressure will need to be controlled so it is in a healthy range. If your child has hypertension, he or she may need to change what they eat and drink. Some children need to take medicines.
Reducing swelling in the body
Very occasionally, children with AKI need to take diuretics. These medicines help reduce oedema (swelling in the body) by removing extra water and salt from your child’s body and by increasing the amount of urine that is passed. Your doctor will examine your child for oedema and measure his or her weight while they are taking diuretics, to check how well the medicine is working.
Common diuretics are: furosemide, spironolactone and metolazone. Other diuretics that may be used are: amiloride, bendroflumethiazide and chlorothiazide.
Managing reduced kidney function
Children with AKI develop reduced kidney function, which means that their kidneys do not work as well as they should. The severity of this varies, but most do not need any special treatment. A very small number will have more serious kidney problems and will need further treatment, such as dialysis. Dialysis uses special equipment or a machine to do what a healthy kidney does – remove waste products and extra water from the body. Dialysis may be needed in some children until their kidneys start working properly again.
There are two main types of dialysis: peritoneal dialysis and haemodialysis. Your child’s healthcare team will decide on the best type for your child.