Acute Renal Failure in Children

Abstract

1. Dilys A. Whyte, MD* 2. Richard N. Fine, MD* 1. *State University of New York at Stony Brook, NY After completing this article, readers should be able to: 1. Define acute renal failure (ARF). 2. Differentiate the three forms of ARF. 3. Initiate treatment, including stabilization, of a patient who has ARF. 4. Discuss the various medications necessary for treating a patient who has ARF. Acute renal failure (ARF) is defined as an acute decline in renal function characterized by an increase in blood urea nitrogen (BUN) and serum creatinine values, often accompanied by hyperkalemia, metabolic acidosis, and hypertension. Significant morbidity and mortality can accompany ARF. Patients who have ARF recover their renal function either partially or completely or they develop end-stage renal disease. They also may develop associated multiorgan disease. ARF is divided into three forms: prerenal failure (most common), intrinsic renal failure, and postrenal failure. Treatment ranges from conservative medical management to dialysis or renal transplantation, depending on the severity of kidney disease and degree of renal function recovery. Worldwide, most cases of ARF in children are due to hemolytic-uremic syndrome or volume depletion. ### Causes Prerenal failure refers to hypoperfusion of the kidneys. There are a variety of causes for such hypoperfusion, the most common of which is hypovolemia due to gastrointestinal (GI) diseases, congenital heart disease, and sepsis (Table 1). | Extracellular Fluid Volume Deficits | || | | | Cardiac Dysfunction | | | Table 1. Causes of Prerenal Acute Renal Failure ### Pathophysiology Prerenal ARF …