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Acute renal failure
1Department of Pediatrics, James Whitcomb Riley Hospital for Children, Indiana University Medical Center, Indianapolis, Indiana 46202, USA. sandreol@uipui.edu
Insights
Hypoxic/ischemic acute renal failure is common in hospitalized children. New insights into its causes and treatments, like hemofiltration, are improving care for pediatric acute kidney injury.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
Background:
- Acute renal failure (ARF) in children presents with elevated creatinine and nitrogenous waste, impairing fluid and electrolyte balance.
- Causes include prerenal disease, intrinsic renal failure (e.g., hypoxic/ischemic insults), and obstructive uropathy.
Purpose of the Study:
- Focus on hypoxic/ischemic ARF, a frequent cause of hospital-acquired ARF in children.
- Review pediatric ARF epidemiology, incidence, and novel pathogenetic insights.
- Discuss evolving therapeutic strategies for pediatric ARF.
Main Methods:
- Literature review focusing on hypoxic/ischemic acute renal failure in pediatric populations.
- Analysis of recent findings on ARF pathogenesis, including nitric oxide/endothelin metabolism, inflammation, and polarity.
- Evaluation of current and emerging treatment modalities.
Main Results:
- Hypoxic/ischemic insults are a primary driver of hospital-acquired ARF in children.
- Pathogenesis involves complex hemodynamic, inflammatory, and cellular polarity changes.
- "Renal dose" dopamine has proven ineffective in adults; hemofiltration is gaining traction.
Conclusions:
- Understanding the pathophysiology of pediatric ARF is crucial for effective management.
- Therapeutic approaches are shifting, with hemofiltration emerging as a key treatment option.
- Continued research is needed to optimize the care of children with acute kidney injury.
Abstract:
Acute renal failure is characterized by an increase in the blood concentration of creatinine and nitrogenous waste products and by the inability of the kidney to appropriately regulate fluid and electrolyte homeostasis. There are many different causes of acute renal failure in children, including prerenal disease, intrinsic renal failure, which includes ischemic hypoxic insults, and obstructive uropathy. This review will focus on hypoxic/ischemic acute renal failure, the most common causes of hospital acquired acute renal failure in children. This review will briefly discuss the epidemiology and incidence of acute renal failure in pediatric patients and review new insights into the pathogenesis of acute renal failure. including hemodynamic alterations induced by alterations in nitric oxide and endothelin metabolism, the role of the inflammatory response, and alteration in polarity in the acute renal failure. The therapy of acute renal failure has changed substantially during the past few years. Controlled trials (in adults) to test the efficacy of "renal dose" dopamine have shown that it is ineffective, and hemofiltration has become increasingly popular as a choice of therapy for acute renal failure.