AKI Documentation and Follow-Up Plan (Pediatric)

Pediatric AKI Discharge Addendum

Patient Name: [Patient full name]

Date of Birth: [DOB (MM/DD/YYYY)]

Discharge Date: [Discharge date (MM/DD/YYYY)]

AKI Episode Summary

Diagnosis: [Explicit statement confirming acute kidney injury occurred during hospitalization]

• KDIGO Stage (highest reached): [Stage 1 / Stage 2 / Stage 3]
• Staging basis: [creatinine criteria / urine output criteria / KRT initiation / creatinine + urine output] (If urine output criteria were not applied due to measurement limitations, state: "Urine output criteria not used due to [reason, e.g., non-catheterized patient].")
• Key values:
  • Baseline creatinine: [value] mg/dL on [date] — [source: prior outpatient value / estimated baseline from lowest stable inpatient value] (If estimated, explicitly note limitation.)
  • Peak creatinine: [value] mg/dL on [date]
  • Discharge creatinine: [value] mg/dL on [date]
• Timing: Onset [date]; Peak severity [date]; Resolution [date / persisting at discharge]
• Recovery status: [Resolved / Improving but not resolved / Persistent AKI / KRT-dependent / Baseline unknown] — [supporting objective data: creatinine trend, urine output if available, KRT status]

Ongoing kidney-related risks/issues:

• [Key risk or issue, e.g., residual impaired function, hypertension risk, proteinuria, nephrotoxin vulnerability, recurrent AKI risk] (Include 1–3 concise bullets as applicable.)

Etiology and Contributing Factors

Primary etiology category: [pre-renal/hemodynamic / intrinsic renal (tubular/interstitial/glomerular/vascular) / post-renal/obstructive / multifactorial / uncertain]

Clinical narrative: [Brief description linking clinical events to AKI, e.g., dehydration, sepsis, cardiac surgery, nephrotoxin exposure, rhabdomyolysis, obstruction] (Do not infer intrinsic etiologies without documented supporting evidence. If uncertain, state this and note whether follow-up depends on further evaluation.)

Supporting findings: [Urinalysis abnormalities, renal ultrasound findings, pertinent serologies with dates] (Include only if clinically significant; omit section if none.)

Nephrotoxin Stewardship

(If no significant nephrotoxin or contrast exposures occurred, state: "No nephrotoxin or contrast exposures requiring stewardship identified" and skip to problem list statement.)

• Inpatient nephrotoxin exposures: [Medications with dates; note concurrent nephrotoxins, prolonged courses, supratherapeutic levels, or exposure during active AKI]
• Iodinated contrast exposure: [Yes with date(s) / None]
• Stewardship actions taken: [Discontinued / Substituted / Dose-adjusted / Hydration / TDM performed — specify details]
• Discharge medication guidance:
  • Avoid: OTC NSAIDs (ibuprofen, naproxen) unless explicitly approved; [other medications to avoid]
  • Nephrotoxin continued at discharge: [Name, indication, planned duration, monitoring schedule] (Include only if applicable.)

Problem list statement: History of AKI—use caution with nephrotoxins; monitor creatinine with high-risk exposures.

Kidney Status at Discharge

• Creatinine: [value] mg/dL on [date]; trend [improving / stable / worsening] from [prior value on date]
• Electrolytes: K [value] mmol/L, HCO3 [value] mmol/L, Phos [value] mg/dL on [date] (Include only if abnormal or requiring monitoring.)
• Fluid status: [euvolemic / hypovolemic / hypervolemic]; [edema present/absent; ongoing diuretics if applicable]
• Blood pressure (last 24 hours): [range] mmHg — [normal / elevated] for age/height (If elevated, specify percentile.)

Residual abnormalities: [Proteinuria/albuminuria quantification, hematuria, structural imaging findings, hypertension requiring therapy, KRT access care needs] (Include only if present; omit this line if none.)

Outpatient Follow-Up Plan

Responsible Clinician: [PCP / Pediatric Nephrology / Specialty Clinic] — [Name and contact if available] (Specify who will order labs, receive results, and contact family.)

Appointments:

• [PCP visit within X days / scheduled date]
• [Nephrology follow-up in X weeks / scheduled date / Not indicated because: brief rationale]

Laboratory Monitoring Timeline:

• Within [X] days: [BMP +/- additional labs]
• At [X] weeks: [Labs]
• At ~3 months: Kidney health reassessment (BMP, urinalysis with spot urine protein/creatinine ratio) to confirm recovery and screen for CKD
• Results routing: [PCP / Nephrology] will receive results and contact family within [X] business days

Urine Testing: [Urinalysis and spot protein/creatinine ratio at X weeks; first-morning sample preferred] (Include only if proteinuria, hematuria, or glomerular process occurred or suspected.)

Blood Pressure Monitoring:

• Location: [PCP office / validated home cuff]
• Frequency: [Every X days/weeks]
• Escalation threshold: [BP above Xth percentile for age/sex/height or >X/X mmHg on repeat checks] — contact [PCP / Nephrology]

Escalation Triggers for Nephrology Referral:

• Rising creatinine or failure to improve by planned checkpoint
• Persistent proteinuria or hematuria on repeat testing
• Hypertension above age/height thresholds
• Recurrent AKI symptoms (markedly decreased urine output with poor intake)
• New concerning findings (electrolyte abnormalities, edema, unexplained fatigue)

Family Instructions:

• Hydration: [Daily fluid guidance appropriate to child's size and clinical context]
• Sick-day guidance: With vomiting, diarrhea, or poor intake — [hold specified medications if applicable]; seek care if unable to keep fluids down or urine output drops
• Medication safety: Avoid OTC ibuprofen/naproxen (NSAIDs) unless specifically instructed by clinician
• Return precautions: Decreased urine output, swelling, persistent vomiting, unusual fatigue — contact [clinic/after-hours line] or seek urgent care

Surveillance Duration: Continue kidney surveillance through at least 3 months post-AKI; extend if abnormalities persist.

(All numeric values must include units and date anchors. If baseline creatinine is uncertain, label explicitly as estimated and note limitation. Recovery status must be documented even if baseline unknown—state limitation and use conservative follow-up plan. If any element cannot be completed at discharge, include placeholder noting who will arrange it and by when.)