Kidney failure in infants and children

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Kidney failure in infants and children

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• Presented byDr.Doaa Al-Masri
• Discussed byDr.Y.K.Abu-Osbaa
• Pediatrics in review vol.23 No.2 February
  2002

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Introduction

• Acute renal failure(ARF)life-threatening ,abrupt
  reduction of urinary output to less than
  300cc/m?2/day.
• High-output renal failure
• Incidence variable.

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Etiology

• Proximal tubular necrosis
• -toxins drugs.
• -sickle cell
  crisis.
• -myoglobulinemia.
• -uric acid.
• -renal vein
  thrombosis.
• In neonates-asphyxia
• -erythroblastosis.
• -mechanical ventilation.

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Lab markers in the differential diagnosis

• Kidney failure index UNa/(U/PCreatinine).
• Fractional excretion of Na
• (U/P)Na/(U/P)Creatini
  ne

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Treatment

• Emergency fluid management
• .PICU management
• Replace insensible water loss loss in volume
  electrolytes from urinary or other outputs.
• Subtract the endogenous water produced from
  tissue catabolism.

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Treatment

• Monitor urine output and other outputs and daily
  weight.
• Careful restoration of caloric,fluid and
  electrolyte losses.
• Administer Lasix.
• Caloric management at least 25 of the daily
  caloric requirement.
• Provision of essential amino acid???!!!

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Hyperkalemia

• K more than 6.5mEq/l with ECG changes requires
  treatment by
• -Ca gluconate.
• -insulin and gucose.
• -kayexalate cation exchange
  resin.

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Metabolic acidosis other complications

• NaCHO3 used when total serum bicorbonate is less
  than 10mmol/L.
• Metabolic alkalosis can develop.
• Seizures (multifactorial)and its management.
• Infection,pericarditis,anemia.

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Indications for dialysis

• 1-serum urea more than 150mg/dl.
• 2-serum creatinine more than 10mg/dl.
• 3-k more than 6.5mEq/l with ECG changes
  unrelieved by medical means.
• 4- severe metabolic acidosis with HCO3 less than
  10mEq/l unrelieved by bicarbonate therapy.
• 5- congestive heart failure fluid overload.
• -Peritoneal vs hemdialysis.
• -Growth hormone and insulin-like growth factor.

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Outcome

• 3 phases of ARF
• Oliguric.
• Diuiretic.
• Recovery.
• The overall survival rate is 70.

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Chronic renal failure

• Clinical presentation
• 1GFR 50-75 of normal for age.
• 2GFR 25-50 of normal for age (chronic renal
  insufficiency)
• -asymptomatic
  proteinuria
• -hyposthenuria
  nocturia
• 3GFR 10-25of normal for age (chronic renal
  failure)
• -anemia acidosis.
• -hyperphosphatemia
  ,hypocalcemia.
• -renal osteodystrophy rickets.
• 4GFR is less than 10 of normal for age.

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Chronic renal failure

• Accelerating factors
• Dehydration .
• Hypertension congestive heart failure.
• Hypercalcemia , hyperuricemia, hypokalemia,
  alkalosis.
• Nephrotoxic agents.

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Complications
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Complications

• Renal osteodystrophy.

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Complications

• Growth failure

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Complications

• Anemia
• Oral Folic acid.
• Oral iron supplement.
• Erythropoietin

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Complications
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Complications

• Metabolic acidosis growth failure
• -increased proteolysis.
• -inhibition of growth hormone pulsatile
  excretion.
• So maintain serum bicarbonate at 22mEq/l.

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Nutritional deficiencies

• Caloric intake should be maintained at the
  recommended dietary allowance for healthy
  children of the same height age, with protein
  kept only to 10 of the total.
• With vigorous caloric protein supplementation
  to reach close to 100 of the recommended dietary
  allowance,weight gain without linear growth
  acceleration or head circumference was
  demonstrated.
• Glucose intolerance in uremia is due to insulin
  resistance.
• The retention of nitrogenous products results in
  anorexia,nausea ,vomiting and uremic stomatitis.

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Other systemic disorders

• Impaired immunolgic defence mechanisms.
• Neurological complication uremic encephalopathy.
• Duodenal ulcers.
• Pericardial effusion pericarditis.
• Pulmonary edema.
• Sexual dysfunction.
• Pruritis .

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Recommendations
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Recommendations

• Treatment of renal osteodystrophy.
• Alkali therapy.
• Phosphate restriction.
• Protein restriction.
• Recombinant human growth hormone.
• Treatment of hypertension.
• Recombinant human erythropoietin.

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The end

• Thank you