NORCET-7 Mains-2024: A child comes in the OPD with acute renal injury (AKI). The possible outcome seen in this child?

NORCET-7 Mains-2024

Child Health Nursing (Pediatrics)

Medium

Appeared in: NORCET-7 Mains-2024

Explanation

Acute Kidney Injury (AKI) is defined by an abrupt decline in kidney function, specifically the glomerular filtration rate (GFR).
Creatinine, a waste product of muscle metabolism, is normally filtered from the blood by the kidneys and excreted in urine.
When GFR decreases in AKI, the kidneys cannot clear creatinine effectively, causing its concentration in the blood to rise.
An increase in serum creatinine is a primary biomarker used to diagnose, stage, and monitor the progression of AKI.

Option A: Urine specific gravity is not consistently decreased in AKI. It is often increased in prerenal AKI (the most common type in children) as the kidneys try to conserve water.
Option C: Blood Urea Nitrogen (BUN) is a nitrogenous waste product cleared by the kidneys. In AKI, impaired filtration causes BUN levels to increase, not decrease.
Option D: The kidneys are the primary organ for potassium excretion. In AKI, this function is impaired, leading to the accumulation of potassium in the blood (hyperkalemia).

Clinical Relevance

Nursing practice connection: Use the key finding related to Laboratory findings in Acute Kidney Injury (AKI) to guide bedside assessment, documentation, and the next nursing action.
Nurses play a critical role in monitoring laboratory values for children with AKI. A rising creatinine is a key indicator of worsening kidney function.
Hyperkalemia (increased potassium) is the most life-threatening complication of AKI. Nurses must be vigilant in monitoring for its signs, such as muscle weakness, and ECG changes (peaked T waves), and report them immediately.
Accurate monitoring of fluid intake and urine output is essential. Fluid is often restricted in oliguric AKI to prevent fluid overload, hypertension, and pulmonary edema.

How to Approach the Question

First, identify the core clinical condition presented in the question: Acute Kidney Injury (AKI) in a child.
Recall the basic pathophysiology of AKI: the kidneys suddenly stop working properly, leading to a failure to filter waste products from the blood.
Based on this pathophysiology, predict the expected changes in laboratory values. Waste products that are normally filtered out will accumulate in the blood.
Evaluate each option against your prediction:
Does creatinine increase or decrease? It's a waste product, so it should increase.
Does BUN increase or decrease? It's a waste product, so it should increase.

Concept Tested & Keywords

Concept Tested: Laboratory findings in Acute Kidney Injury (AKI)
Stem keywords: child, acute renal injury, AKI, outcome
Lead-in keywords: possible outcome
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.

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