Acute renal failure in paediatrics: Diagnosis and management

Abstract

Except during neonatal period, acute renal failure is less frequent in children than in adults. The two leading causes in paediatric population are hemolytic-uremic syndromes observed in infants and in young children less than 3 years and acute renal failure related to renal hypoperfusion that occurred in all ages. In new-borns, acute renal failure is mainly related to perinatal asphyxia. Hyperkalaemia and fluid overload are life-threatening complications, which have to be promptly prevented by treatment. Technical advances in renal replacement therapies (peritoneal dialysis, hemodialysis and continuous hemofiltration) permit to provide stable control of fluid and metabolic status with sufficient caloric intake even in hemodynamically unstable patients and in tiny infants. Peritoneal dialysis remains the favorite method of dialysis in infants and young children even if continuous hemofiltration takes a growing place, particularly in treatment of multiple organ failure. Nowadays, mortality observed in acute renal failure is mainly associated with extra-renal pathologies and is higher in neonatal period and in critically ill children. Risk of irreversible renal lesions with chronic renal failure is variable depending of aetiology and duration of acute renal failure.