Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
Acute Renal Failure: Definition, Causes, Symptoms and Treatment
1. Acute Renal failure
Dr. Abhijeet Deshmukh
Dept. of Pediatrics
Pushpagiri Medical College & RC
Tiruvalla, Kerala
2. Definition
• A clinical syndrome in which a sudden
deterioration in renal function results in the
inability of the kidneys to maintain fluid and
electrolyte homeostasis.
• Also k/a Acute renal insufficiency
• 2-3% of children admitted to pediatric tertiary
care centres
• 8% of infants in neonatal ICU.
8. • Sensitivity and specificity of urine Na of <20
in differentiating prerenal azotemia from
acute tubular necrosis are 90% and 82%,
respectively.
• Fractional excretion of sodium
= urine:plasma (U/P) ratio of sodium divided
by U/P of creatinine × 100.
(sensitivity and specificity of fractional excretion of
sodium of <1% in differentiating prerenal
azotemia from acute tubular necrosis are 96%
and 95%, respectively)
9. • CXR : cardiomegaly, pulmonary
congestion (fluid overload) or pleural
effusions.
• Renal USG :
hydronephrosis /hydroureter,
Nephromegaly- s/o intrinsic renal disease.
• Renal biopsy : who do not have clearly
defined prerenal or postrenal ARF
10. • Other biomarkers:
- changes in plasma neutrophil
gelatinase-associated lipocalin (NGAL)
and cystatin C levels
- urinary changes in NGAL, interleukin18 (IL-18), and kidney injury molecule-1
(KIM-1).
12. If there is no evidence of volume
overload or cardiac failure, intravenous
administration of isotonic saline, 20 mL/kg
over 30 min.
13. hypovolemic patients generally void
within 2 hr after bolus; failure points to
intrinsic or postrenal ARF.
Hypotension due to sepsis - vigorous
fluid resuscitation f/b continuous infusion
of norepinephrine.
14. • Diuretic therapy :
only after the adequate hydration.
Mannitol (0.5 g/kg) and furosemide (2-4 mg/kg) - as a
single IV dose. [Mannitol - effective in pigment
(myoglobin, hemoglobin)-induced renal failure.]
Bumetanide (0.1 mg/kg)- an alternative to furosemide.
If urine output is not improved - continuous diuretic
infusion may be considered.
Consider Dopamine (2-3 µg/kg/min) in conjunction
with diuretic therapy.
There is little evidence that diuretics or dopamine can
prevent ARF or hasten recovery.
15. • Hyperkalemia
• Sr K >6 mEq/L - cardiac arrhythmia, cardiac arrest, and death.
• Earliest ECG change - peaked T waves f/b widening of the QRS
intervals, ST segment depression, ventricular arrhythmias, and
cardiac arrest.
• Exogenous sources of K : dietary, intravenous fluids, total parenteral
nutrition) should be eliminated.
• Sodium polystyrene sulfonate resin (Kayexalate) : (1 g/kg) - orally or
by retention enema when Sr K>6 mEq/L
- exchanges sodium for potassium
- can take several hours to take effect. A single dose of 1 g/kg
can lower the sr K level by about 1 mEq/L.
- Resin therapy may be repeated every 2 hr, the frequency
being limited primarily by the risk of sodium overload.
16. • If Sr K >7 mEq/L : emergency measures in
addition to Kayexalate.
Calcium gluconate 10% solution :
1.0 mL/kg IV, over 3-5 min
Sodium bicarbonate :1-2 mEq/kg IV, over
5-10 min
Regular insulin : 0.1 U/kg, with glucose
50% solution, 1 mL/kg, over 1 hr
17. • Mild metabolic acidosis:
common in ARF - rarely requires
treatment.
If severe (arterial pH < 7.15; serum
bicarbonate < 8 mEq/L) or contributes to
hyperkalemia it should be corrected.
18. • Hypocalcemia :
- Primarily treated by lowering the serum
phosphorus level.
- Calcium should not be given IV except
in cases of tetany, to avoid deposition of
calcium salts into tissues.
- Follow a low-phosphorus diet,
19. • Hyponatremia
- most commonly a dilutional
- must be corrected by fluid restriction.
- hypertonic (3%) saline - limited to
symptomatic hyponatremia
(seizures, lethargy) or those with a serum
sodium level <120 mEq/L.
20. • GI bleeding
because of uremic platelet
dysfunction, increased stress, and heparin
exposure in hemodialysis.
Oral or intravenous H2 blockerRanitidine.
21. • Hypertension
Common in ARF patients with acute
glomerulonephritis or HUS.
Salt and water restriction, diuretics
Isradipine (0.05-0.15 mg/kg/dose,
amlodipine, 0.1-0.6 mg/kg/24 hr qd or divided bid
propranolol, 0.5-8 mg/kg/24 hr divided bid or tid;
labetalol, 4-40 mg/kg/24 hr divided bid or tid
severe symptomatic hypertension - continuous
infusions of sodium nitroprusside or esmolol
22. • Neurologic symptoms
Headache, seizures, lethargy, and confusion
(encephalopathy).
Potential etiologic factors - hyponatremia,
hypocalcemia, hypertension, cerebral
hemorrhage, cerebral vasculitis, and the
uremic state.
Diazepam - most effective in controlling
seizures,
Treat the underlying cause.
23. • Anemia of ARF
generally mild
packed red blood cells if Hb < 7 g/dL
Slow (4-6 hr) transfusion with packed red
blood cells (10 mL/kg) diminishes the risk
of hypervolemia.
24. • Nutrition
In most cases, sodium, potassium, and
phosphorus should be restricted.
Protein – restricted & caloric intake
maximised to minimize the accumulation
of nitrogenous wastes.
Critically ill patients with ARF - parenteral
essential amino acids given
25. • Protein :
enough protein for growth - limiting high protein intake.
Protein needs increase on dialysis.
Foods with protein include
eggs
milk
cheese
chicken
fish
red meats
beans
yogurt
cottage cheese
26. • Sodium.
Depend on stage of their kidney disease, their
age, and sometimes other factors.
Foods high in sodium include
• canned foods
• some frozen foods
• most processed foods
• some snack foods, such as chips
31. Referances
• Nelson Textbook of pediatrics 19 th edition
• Treatment Methods for Kidney Failure in
Children (National instt. of Diabetes & Kidney
disease)