Management of acute renal failure in the newborn

Acute renal failure is common in the neonatal period. It is usually manifest by abnormal biochemistry and decreased urine output (<1 ml/kg/h), but non-oliguric renal failure is also common. A detailed understanding of the common pathophysiological mechanisms is rarely needed but an understanding of the common aetiologies (pre-renal, renal and post-renal) will enable the clinician to approach the problem in a logical manner. A standard approach to fluid and electrolyte management is described, along with a practical approach to the investigation and management of renal failure. A working understanding of the principles of peritoneal dialysis is important and a brief overview of the role of haemodialysis in neonatal renal failure is provided.