Prevention of acute renal failure in children

Prevention of acute renal failure in children

Abubakr Imam, MD, FAAP

INTRODUCTION — Acute renal failure (ARF) is defined by a rapid decline in glomerular filtration rate, resulting in the disturbance of renal physiological functions including [1-3]: Impairment of nitrogenous waste product excretion Loss of water and electrolyte regulation Loss of acid-base regulation
ARF is an important contributing factor to the morbidity and mortality of critically ill infants and children [4].
The prevention and treatment of ARF is presented in this topic review. The clinical manifestations and diagnosis of ARF in children and the approach to ARF in the neonate are discussed separately. (See "Clinical presentation, evaluation and diagnosis of acute renal failure in children" and see "Acute renal failure in the newborn").

PREVENTION OF ARF — General measures to help prevent ARF include close monitoring of serum levels of nephrotoxic drugs, adequate fluid repletion in those with hypovolemia, and aggressive hydration and alkalinization of the urine prior to chemotherapy. (See "Pathogenesis and prevention of aminoglycoside nephrotoxicity and ototoxicity", see "Amphotericin B nephrotoxicity", see "Treatment of hypovolemia (dehydration) in children", and see "Overview of the treatment and outcome of acute lymphoblastic leukemia in children", section on Tumor lysis).
Thus, a child with a clinical history consistent with fluid loss (such as vomiting and diarrhea), a physical examination consistent with hypovolemia (hypotension and tachycardia), and/or oliguria requires immediate intravenous fluid therapy in an attempt to restore renal function and perhaps prevent ischemic renal injury. Commonly used fluids are crystalloid solutions, such as normal saline (20 mL/kg) administered over 20 to 30 minutes, which may be repeated. If urine output does not increase and renal function fails to improve with the restoration of intravascular volume, invasive monitoring may be required to adequately assess the child's fluid status and help guide further therapy. However, such fluid infusion is contraindicated in those with obvious volume overload or heart failure. (See "Intravascular volume" below).

The efficacy of more specific preventive therapy in children at risk for postischemic ATN is unproven. Mannitol, furosemide, and low doses of intravenous dopamine have been evaluated with either inconclusive results or no evidence of benefit. These agents also have been used in an attempt to convert oliguric to non-oliguric ATN. (See "Possible prevention and therapy of postischemic acute tubular necrosis").

Each of these therapies also are associated with potential toxicity and adverse effects: Mannitol can result in significant intravascular volume expansion, which with continued renal insufficiency can lead to pulmonary edema, hyponatremia, and acidosis. (See "Complications of mannitol therapy"). Ototoxicity is associated with high doses of intravenous furosemide. (See "Optimal dosage and side effects of loop diuretics"). Low-dose (eg, renal dose) dopamine has been associated with tachycardia, arrhythmias, and myocardial ischemia. (See "Renal actions of dopamine" and see "Possible prevention and therapy of postischemic acute tubular necrosis").

Although mannitol, furosemide, and low-dose dopamine are sometimes used for prevention of acute tubular necrosis in kidney transplantation recipients, they are not generally recommended in the prevention of acute tubular necrosis in children.

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أني ولو مو طبيب بس أريد أشكرك من كل قلبي وأكلك كل عام وأنت بألف خير وأتم صحة وعافية والله يخليك تتحف المنتدى بالمواضيع المفيدة والمهمة وخصوصا للأطباء والعاملين بالحقل الطبي مشكوررررررررررررررررررررررررررررررررررررررررررررررررررررررررررر

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السلام عليكم
شكرا لك دكتور سالم على ما اتحفتنا به .. من معلومات قيمة
ودوما بانتضار جديدك ..

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» Acute renal failure in the newborn diagnosis & management
» Acute renal failure in the newborn ,management(cont.)
» الفشل الكلوي الحاد Acute Renal Failure
» Acute renal failure in the newborn etiology & pathophysiology
» ( Management, prognosis, and prevention of UTI -(1