Pediatric Nephrology Experts Discuss Severe Kidney Injury During Surgery

Pediatric Nephrology Expert WitnessThis case involves a young male patient in Kentucky who was seen by his pediatrician with decreased appetite, slight fever, and malaise. Laboratory testing as well as imaging studies revealed the presence of a small bowel obstruction. After conservative treatment failed to produce any results, the child was taken in for surgery to remove the obstruction. While under general anesthesia, the child suffered kidney failure as well as cardiac arrest due to a previously unknown hereditary disorder. Despite attempts to save the child’s life he expired shortly after the surgery was completed.

Question(s) For Expert Witness

  • 1. Are you able to help us determine what caused the kidney failure?
  • 2. Are you determine whether or not a spike in CK levels correlated with this patient's kidney failure?

Expert Witness Response E-005880

I have been a board certified pediatric nephrologist for 25 years, with lots of experience with infants and children with chronic kidney disease or requiring dialysis. I think that trying to connect the kidney failure to a spike in CPK will be challenging. The severe brain injury would not be expected to come from a spike in CPK. That would indicate a profound low blood pressure which could easily affect other organs especially the kidney. Trying to identify causation limited to the spike in CPK without including the rest of the patient situation would be challenging if not impossible to separate.

Expert Witness Response E-050867

I am Board certified in Pediatric Nephrology, and a specialist in acute kidney injury. I am currently an Assistant Professor, Pediatrics, Medicine & Bioengineering at a major university medical center, as well as a Pediatric Nephrologist at a prominent children’s hospital. I am able to determine what caused the kidney failure. It is likely multifactorial if there was malignant hyperthermia as well as cardiac arrest with ischemic injury to the kidneys. The child may also have received nephrotoxic medications around this time. If CK levels quite high, with corresponding chemical hematuria, then yes, it is quite likely that the CK levels correlated with this patient’s kidney failure.


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