The management of neonatal acute and chronic renal failure: A review

Area of Science:

• Pediatric Nephrology
• Critical Care Medicine
• Renal Replacement Therapy

Background:

• Chronic renal failure in infants is often diagnosed prenatally, with many receiving kidney transplants before school age.
• Acute kidney injury (AKI) in infants frequently stems from hypotension post-cardiac surgery or multiple organ failure.
• The definition and diagnosis of AKI in infants are complex, with plasma creatinine offering sensitive early indicators.

Purpose of the Study:

• To review the challenges in managing acute kidney injury in infants.
• To highlight the limitations of current renal replacement therapies in neonates and young children.
• To introduce newer devices designed to overcome these therapeutic hurdles.

Main Methods:

• Review of current literature on infant acute kidney injury and renal replacement therapy.
• Discussion of the physiological changes and diagnostic criteria for AKI in this population.
• Evaluation of the technical difficulties associated with peritoneal dialysis and hemodialysis in infants.

Main Results:

• Conservative management of AKI can lead to malnutrition or fluid overload.
• Peritoneal dialysis in neonates is often technically challenging.
• Hemodialysis in infants is limited by vascular access, anticoagulation, circuit priming, and fluid removal regulation.

Conclusions:

• Accurate interpretation of plasma creatinine is crucial for early AKI detection in infants.
• Existing renal replacement therapies pose significant challenges in very small patients.
• Novel devices, such as the Nidus, are being developed to improve the safety and efficacy of AKI treatment in infants.