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Acute Renal Failure

Acute renal failure (ARF) is a clinical syndrome in which a sudden deterioration in renal function results in the inability of the kidneys to maintain fluid and electrolyte homeostasis. ARF occurs in 2–3% of children admitted to pediatric tertiary care centers and in as many as 8% of infants in the neonatal intensive care unit. Oliguria (Urine flow <1 ml/kg/hr) or Anuria is common presentation but rarely urine output may be normal.

Common Causes of Acute Renal Failure

  1. Prerenal
    Dehydration, Hemorrhage, Sepsis, Hypoalbuminemia, Cardiac failure 
  2. Intrinsic Renal
    Glomerulonephritis, Postinfectious/Poststreptococcal, Lupus erythematosus, Henoch-Schönlein purpura. Membranoproliferative, Anti–glomerular basement membrane, Hemolytic-uremic syndrome, Acute tubular necrosis, Cortical necrosis, Renal vein thrombosis, Rhabdomyolysis, Acute interstitial nephritis, Tumor infiltration, Tumor lysis syndrome 
  3. Postrenal
    Posterior urethral valves, Ureteropelvic junction obstruction, Ureterovesicular junction obstruction, Ureterocele, Tumor, Urolithiasis, Hemorrhagic cystitis, Neurogenic bladder 

Presence of the following suggests the possibility of a chronic renal disease

  1. Retardation of growth                  
  2. Severe anemia
  3. Hypertensive retinopathy                      
  4. Hypocalcemia
  5. Hyperphosphatemia                    
  6. Osteodystrophy            
  7. Small contracted kidneys


Indications for dialysis:

  1. Volume overload with evidence of hypertension and/or pulmonary edema refractory to diuretic therapy
  2. Persistent hyperkalemia
  3. Severe metabolic acidosis unresponsive to medical management
  4. Neurologic symptoms (altered mental status, seizures)
  5. Blood urea nitrogen greater than 100–150?mg/dL (or lower if rapidly rising)
  6. Calcium/phosphorus imbalance, with hypocalcemic tetany 

Peritoneal dialysis/ Continuous hemofiltration


ARF in Newborn- common causes are

  1. Asphyxia                      
  2. Shock
  3. Septicemia                  
  4. RDS

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