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Acute renal failure.

Sharon Phillips Andreoli1

  • 1Department of Pediatrics, James Whitcomb Riley Hospital for Children, Indiana University Medical Center, Indianapolis, Indiana 46202, USA. sandreol@uipui.edu

Current Opinion in Pediatrics
|May 1, 2002
PubMed
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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.

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  • 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.