Objectives After completing this article, readers should be able to: 1. Recognize and delineate the causes of acute renal failure. 2. Formulate emergency management of fluid electrolyte disorders in acute renal failure. 3. Characterize the incidence, causes, and costs of chronic renal failure in children. 4. Explain the pathogenesis and treatment of complications of chronic renal failure. 5. Delineate a plan to help the family with the outcome of renal failure. Acute Renal Failure Incidence and Causes ARF is encountered in 3% to 10% of all admissions to neonatal intensive care units. In our experience with a regional pediatric nephrology program serving a catchment area of 1.5 million general population, 6.4% of 3,154 children referred to the program from community physicians suffered from ARF. However, precise figures on the true incidence of ARF in childhood are surprisingly sparse. ARF is a life-threatening, abrupt reduction of urinary output to less than 300 mL/m 2 per day that is precipitated by prolonged renal ischemia in most cases. Occasionally, it may present with a high urinary output but mounting serum urea nitrogen and creatinine levels, the so-called "high output" or "nonoliguric" ARF, more often following severe burns or open heart surgery. The three leading causes of acute renal failure in children (Table 1) in developing countries are: hemolytic-uremic syndrome (31%), glomerulonephritis (23%), and postoperative sepsis/prerenal ischemia (18%). In contrast, for industrialized countries, the three most common causes are: intrinsic renal disease (44%), postoperative septic shock (especially after open heart surgery) (34%), and organ/bone marrow transplantation (13%). Proximal tubular necrosis may follow toxic ingestions (eg, carbon tetrachloride, diethylene glycol, arsenic, mercury, gold, lead, and other heavy metals). Medications, such as
Acute kidney failure following repair of cardiac lesions remains unchanged as a leading risk factor of mortality in both decades. Three organ system failures were associated with more than a 50% mortality rate. Predialysis low serum albumin concentrations emerged as a significant copredictor of mortality.
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