Acute Renal Failure - Renal Disease in Children

Acute Renal Failure

·        = Acute renal 'success'. If kidney didn‟t shut down after ATN, would continue filtering at 1-2 l/hr with no reabsorption ® very rapid dehydration

·        Causes:

o  Ischaemia

o  Obstruction (eg congenital malformation)

o  Sepsis: toxins killing tubular cells + hypoperfusion

o  Drugs: at glomeruli or tubular cells

·        Complications: 

o  Fluid overload: fluid restrict to insensible losses (breath, stools, skin = 400 mls/m2 of body surface) plus urine and vomit

·        Hyperkalaemia:

o   No symptoms, so have to monitor 

o   Treatment: salbutamol or insulin + glucose ® shifts K into ICF

o   Calcium resonium: chelates K 

o   Encourage anabolism with ­ calories ® ­cell creation

o   Frusemide if any urine output

o   CaCl or Ca Gluconate: prevents arrhythmia

o   Dialysis

·        Uraemia: vomiting, encephalopathy ® dialysis

·        Hypertension: due either to ­aldosterone release or fluid overload