Advances in Critical Care Pediatric Nephrology: Point of Care Ultrasound and Diagnostics

Preface
Contents
About the Editors
Part I: Point of Care Ultrasound
	1: Need for Point of Care Ultrasound in Critical Care Pediatric Nephrology
		1.1	 Advantages of POCUS
		1.2	 Disadvantages of POCUS
		1.3	 Main Applications in Critical Care Pediatric Nephrology
		References
	2: Modes and Equipment
		2.1	 Introduction
		2.2	 Physics of Ultrasound
		2.3	 Ultrasound Jelly or Gel
		2.4	 Interactions of Ultrasound with Tissues
		2.5	 Equipment–Machine and Transducers
		2.6	 Image Orientation and Transducer/Probe Position
		2.7	 Modes
		2.8	 What Is Echogenicity?
		2.9	 How to Conduct an Ultrasound Examination of a Child?
		2.10	 Technique
		2.11	 Conclusion
		References
	3: Sonography of the Kidneys in Children: Basics
		3.1	 Fetal Genitourinary Tract
			3.1.1	 Peculiarities in Renal Sonography in Neonates and Infants
		3.2	 Congenital Anatomical Variants
		3.3	 Bladder Outlet Obstruction
		3.4	 Cystic Renal Disease
			3.4.1	 Multicystic Dysplastic Kidney
			3.4.2	 Autosomal Dominant Polycystic Kidney Disease [ADPKD]
			3.4.3	 Autosomal Recessive Polycystic Kidney Disease [ARPKD]
			3.4.4	 Nephronophthisis
		3.5	 Renal Stone Disease and Nephrocalcinosis
			3.5.1	 Renal Stone Disease
			3.5.2	 Nephrocalcinosis
		3.6	 Antenatal and Postnatal Hydronephrosis
			3.6.1	 Antenatal Hydronephrosis
			3.6.2	 Postnatal Assessment of Antenatally Diagnosed Hydronephrosis
		3.7	 Vascular Anomalies
			3.7.1	 Renovascular Hypertension
			3.7.2	 Renal Vein Thrombosis [RVT]
			3.7.3	 Arteriovenous Malformation and Fistula
			3.7.4	 Nutcracker Syndrome
		3.8	 Acute Kidney Injury [AKI]
		3.9	 Chronic Kidney Disease [CKD]
		3.10	 Transplantation
		3.11	 Conclusion
	4: Ultrasound Guided Procedures in PICU
		4.1	 CVCs Insertion Under Ultrasound Guidance
			4.1.1	 Ultrasound Machine
			4.1.2	 Ultrasound Views
			4.1.3	 Probes Selection
			4.1.4	 Procedure
			4.1.5	 The Common Approaches to CVCs by US Guidance
		4.2	 Kidney Biopsy Under Ultrasound Guidance
			4.2.1	 Indications for Renal Biopsy
			4.2.2	 Contraindication for Renal Biopsy
			4.2.3	 Biopsy Needles
			4.2.4	 Procedure
			4.2.5	 Complications
		4.3	 Suprapubic Aspiration Under Guidance of Ultrasound
		References
	5: Lung and Cardiac Ultrasound for Assessment of Intravascular Volume Status in Children
		5.1	 Introduction
		5.2	 Lung Ultrasound
		5.3	 Technique
		5.4	 Interpretation
		5.5	 Focused Cardiac Ultrasound
		5.6	 Effusion
		5.7	 Ejection
		5.8	 Equality
		5.9	 Entrance
		5.10	 Exit
		5.11	 Summary and Clinical Integration
		References
	6: Use of Point of Care Ultrasound in Access for Dialysis: Hemodialysis and Peritoneal Dialysis
		6.1	 Introduction
		6.2	 Role of Ultrasound (US) for Hemodialysis Vascular Access
			6.2.1	 Central Venous Catheter (CVC) Insertion: US-Guided Needle Placement
			6.2.2	 AV Access
		6.3	 Role of Ultrasound (US) in Peritoneal Dialysis Catheter Placement
			6.3.1	 Assessment of Abdominal Wall Thickness
			6.3.2	 Assessment of Blood Vessels
			6.3.3	 Assessment of Intra-Abdominal Adhesions
			6.3.4	 Assessment of the Urinary Bladder
		References
	7: Focused Echocardiogram: A Case Based Approach
		7.1	 Clinical Scenario
			7.1.1	 Case 1
			7.1.2	 Case 2
		7.2	 Focused Echocardiogram
		7.3	 Basic Requirements for Focused Echocardiogram
		7.4	 The Applicability of FOCUS in Critically Ill Patients
			7.4.1	 Left Ventricular Systolic Dysfunction
			7.4.2	 Pericardial Effusion (PEff)
			7.4.3	 Pulmonary Edema (PE)
		References
	8: Focused Cardiac Ultrasound (FOCUS) in Pediatric Intensive Care
		8.1	 Introduction
		8.2	 Technique
			8.2.1	 Transducer Choice and Preset
			8.2.2	 Patient Preparation
		8.3	 Transducer Orientation and Cardiac Views
			8.3.1	 Parasternal Long-Axis View
			8.3.2	 Parasternal Short-Axis View
			8.3.3	 Apical Four-Chamber View
			8.3.4	 Subxiphoid View
			8.3.5	 Inferior Vena Cava View
		8.4	 Pathology Identified Through Focused Echocardiogram
			8.4.1	 Cardiac Function
			8.4.2	 Cardiac Asystole
			8.4.3	 Pericardial Effusion and Tamponade
			8.4.4	 Pericardiocentesis
			8.4.5	 Hydration Status
		8.5	 FOCUS Limitations in the Pediatric ICU
		8.6	 Conclusion
		References
	9: Need for Point of Care Ultrasonography Training and Certification in Pediatric Nephrology
		9.1	 Introduction
		9.2	 Scope of Practice
		9.3	 Training
		9.4	 Competency Assessment and Learner Feedback
		9.5	 Procuring Ultrasound Machine and Logistics
		References
Part II: Newer Biomarkers in Acute Kidney Injury
	10: Fluid Overload and Kidney Injury Score
		10.1	 Introduction
		10.2	 AKI Current Definitions and Limitations
		10.3	 Fluid Overload: Definitions and Clinical Significance
		10.4	 Early Intervention Strategies to Prevent AKI and Fluid Overload
		10.5	 Nephrotoxic Injury Negated by Just-in-Time Action
		10.6	 Renal Angina Index
		10.7	 Fluid Overload and Kidney Injury Score
		10.8	 Limitations of FOKIS
		10.9	 Conclusion
		References
	11: Renal Oximetry in Neonates and Children During Cardiac Surgery
		11.1	 Some Practical Considerations
		11.2	 Baseline Renal NIRS Measurements and Influential Perioperative Factors
		11.3	 Acute Kidney Injury and Renal NIRS
		11.4	 Perioperative Renal Monitoring
		References
	12: Defining Acute Kidney Injury in Children
		12.1	 Introduction
		12.2	 Metrics of Renal Injury, Function, and Dysfunction
			12.2.1	 Serum Creatinine
			12.2.2	 Urine Output
			12.2.3	 Glomerular Filtration Rate
			12.2.4	 Urinary AKI Biomarkers
		12.3	 Defining Acute Kidney Injury
			12.3.1	 Risk, Injury, Failure, Loss, ESRD (RIFLE) Criteria
			12.3.2	 Pediatric RIFLE (pRIFLE) Criteria
			12.3.3	 Acute Kidney Injury Network Criteria
			12.3.4	 Kidney Disease: Improving Global Outcomes
		12.4	 Summary
		References
	13: Genetic Influences on Pediatric AKI
		13.1	 Introduction
		13.2	 Clinical Context
		13.3	 Genetic Study Approaches
		13.4	 AKI Heterogenicity and Genetics
		13.5	 Systematic Review
		13.6	 Conclusions
		References
	14: New Markers of Acute Kidney Injury in Children Undergoing Hematopoietic Stem Cell Transplantation
		14.1	 Introduction
		14.2	 New Understanding of AKI
		14.3	 Serum Markers of Function
			14.3.1	 Cystatin C
		14.4	 Urinary Markers of Damage
			14.4.1	 Neutrophil Gelatinase-Associated Lipocalin
			14.4.2	 Kidney Injury Molecule (KIM)-1
			14.4.3	 Interleukin (IL)-18
			14.4.4	 Liver-Type Fatty Acid-Binding Protein
			14.4.5	 Reference Ranges of Damage Markers in Children
		14.5	 New Perspectives
			14.5.1	 Insulin-Like Growth Factor-Binding Protein-7
			14.5.2	 Tissue Inhibitor of Metalloproteinase-2
		14.6	 Practical Approach
		14.7	 Conclusions
		References
	15: Limitations of Glomerular Filtration Rate Estimation in Pediatric Acute Kidney Injury
		15.1	 Introduction
			15.1.1	 Renal Function in the Growing Child
			15.1.2	 The Importance of Correct Drug Dosing in the Setting of Developmental Changes and Acute Kidney Injury
			15.1.3	 Inaccuracies of Predicting Vancomycin Clearance in the Acute Kidney Injury Setting, Both in the Neonates and Older Children
		15.2	 Renal Elimination of Drugs
		15.3	 Renal Drug Clearance in the Growing Child
			15.3.1	 Why GFR Does Not Necessarily Predict Renal Drug Clearance
		15.4	 Gold Standard of Measuring GFR and Effective Renal Plasma Flow (ERPF)
			15.4.1	 Clearance
			15.4.2	 Inulin Clearance
			15.4.3	 Autoregulation
			15.4.4	 Effective Renal Plasma Flow
		15.5	 Current Approach to Estimation of GFR
		15.6	 Novel Approaches
		15.7	 Conclusions
		15.8	 Practical Advice
		15.9	 Key Points
		References
	16: Applied Metabolomics and Emerging Biomarkers in Neonatal Acute Kidney Injury
		16.1	 Introduction
		16.2	 Metabolomics
		16.3	 Biomarkers
			16.3.1	 NGAL
			16.3.2	 Cystatin C
			16.3.3	 KIM-1
			16.3.4	 IL-18
			16.3.5	 Netrin-1
		16.4	 Summary
		References
	17: CKD Management Post-AKI: The Role of Biomarkers
		17.1	 The Basics
		17.2	 Current Diagnostic Criteria for AKI
		17.3	 Current Diagnostic Criteria for CKD
		17.4	 Progression from AKI to CKD
		17.5	 Biomarkers for AKI and Progression to CKD
			17.5.1	 Cystatin C
			17.5.2	 Neutrophil Gelatinase-Associated Lipocalin (NGAL)
			17.5.3	 Liver-Type Fatty Acid Binding Protein (L-FABP)
			17.5.4	 Kidney Injury Molecule-1 (KIM1)
			17.5.5	 Soluble Urokinase Plasminogen Activator Receptor (suPAR)
			17.5.6	 IL-18
			17.5.7	 FGF23 and Endothelium Biomarkers
		17.6	 Biomarkers for AKI Without Current Studies Evaluating Their Role in CKD Progression
			17.6.1 Tissue Inhibitor of Metalloproteinases-2 (TIMP-2) and Insulin-Like Growth Factor-Binding Protein-7 (IGFBP7)
			17.6.2 Renal Resistive Index (RRI)
		17.7	 Future Directions
		References
	18: Functional Renal Reserve and Furosemide Stress Test
		18.1	 Introduction
		18.2	 Glomerular Filtration Rate (GFR) and Concept of Functional Renal Reserve
		18.3	 Oral Protein Intake Increases GFR: The Protein Tolerance Test
		18.4	 The Stress GFR (or the Glomerular Stress Test) and the Tubular Stress Test
			18.4.1	 Tubular Stress Test
			18.4.2	 Utility of Stress Testing
		18.5	 Renal Functional Reserve as Biomarker
		18.6	 Renal Functional Reserve in AKI and CKD
		18.7	 Furosemide Stress Test: Physiology and Pharmacology of Loop Diuretics
			18.7.1	 Caveats with FST
		18.8	 Current Evidence on FST
		18.9	 Conclusions
		References
	19: Up-to-Date Systematic Approach to the Spectrum of Thrombotic Microangiopathy
		19.1	 Introduction
		19.2	 Classifications
		19.3	 Pathophysiology
			19.3.1	 TMA Caused by STEC-HUS
			19.3.2	 TMA Caused by Complement Dysregulation
			19.3.3	 Thrombotic Thrombocytopenic Purpura
		19.4	 Clinical Manifestation
		19.5	 Diagnosis
		19.6	 Treatment
			19.6.1	 General Measures
			19.6.2	 Specific Therapeutic Measures
		References