Acute Renal Failure in Children - Causes and Treatment

What Is Acute Renal Failure?

Acute renal failure is a permanent or temporary loss of kidney function. The two types of renal diseases commonly found are:

• Acute Kidney Disease: Acute kidney disease in children occurs very suddenly, which takes less than two days, and the condition may sometimes be reversed, and the kidney starts functioning normally.

• Chronic Kidney Disease: Chronic renal failure occurs slowly and worsens at least after three weeks of onset, mostly leading to permanent kidney failure. Kidney failure may be severe, but various treatments will help the child come out of the condition. Acute kidney failure causes morbidity in children who are critically ill and cause damage to the kidney, which is the central mediator of hemostasis of the body. The causes, symptoms, and treatment options differ for acute and chronic kidney failure.

What Are the Causes of Acute Renal Failure?

Any injury that leads to a severe loss of blood, surgery, or shocks may result in decreased blood supply to kidneys, and insufficient blood supply to kidneys results in kidney failure. The causes of renal failure may include but are not limited to the following:

• Any obstruction or blockage in the urinary tract. Blood clots from cholesterol may lead to renal failure.

• Any autoimmune disease.

• The hemolytic uremic syndrome is caused by an Escherichia coli infection, which obstructs small functional structures and vessels in the kidney resulting in acute renal failure in children. The condition is called a hemolytic uremic syndrome.

• Intake of a few medications that result in renal failure in children.

• A type of kidney disease called glomerular nephritis. In this condition, the glomerulus gets inflamed and affects the kidney's ability to filter urine, resulting in acute or chronic renal failure.

• A condition affecting blood flow to the kidneys results in acute renal failure.

What Are the Causes of Chronic Renal Failure?

Long-term urinary tract obstruction or urinary tract blockage leads to chronic renal failure. The causes of chronic renal failure include:

• Alport Syndrome: A genetic disorder, which is inherited and results in deafness, vision problems, and progressive kidney damage.

• Nephrotic Syndrome: Nephrotic syndrome is determined by protein in the urine, low protein in the blood, high cholesterol levels, and tissue swelling, which results in chronic renal failure.

• Genetical Disorders: Such as polycystic kidney disease, like cysts in the kidney, are fluid-filled, resulting in chronic renal failure.

• Cystinosis: It is an inherited disorder in which the amino acid cystine (a joint protein-building compound) accumulates within specific cellular bodies of the kidney, known as lysosomes, and obstructs urine filtration, which results in chronic renal failure.

What Are the High-Risk Factors in Children for Developing This Disease?

Children with the following are at high risk for developing acute renal failure:

• Blockage in the urinary tract.

• The child with blood loss, surgery, or any shock.

• Children who are taking medications that cause kidney failure.

• A condition called cardiac arrest may obstruct blood supply, and oxygen supply to kidneys is more prone to acute renal failure.

• Children suffering from nephrotic syndrome and glomerular nephritis are at high risk for acute renal failure.

Children with the following are at high risk for developing chronic renal failure:

• Long-term blockage of the urinary tract.

• Nephrotic syndrome.

• Polycystic syndrome.

• Children with Alport syndrome.

• Children with underlying untreated conditions like untreated blood pressure, untreated hypertension, and untreated acute renal failure are at risk of chronic renal failure.

What Are the Symptoms of Acute Renal Failure?

The symptoms of acute renal failure include:

• Bleeding (hemorrhage) is also seen in acute renal failure.

• Fever due to obstruction leads to infection in the urinary tract.

• Rashes.

• Bloody diarrhea.

• Severe vomiting.

• Stomach pain.

• No urine or excess urine.

• Pale skin.

• Swelling of the tissues.

• Inflammation of the eye.

• Stomach mass.

The symptoms of chronic renal failure include:

• Loss of appetite or poor appetite due to the metallic taste or altered taste of food.

• Vomiting or stomach upset.

• Bone pain.

• Headache.

• Stunted growth.

• Fatigue or extreme tiredness.

• Lots of urine or no urine.

• Recurrent urinary tract infections.

• Urinary incontinence.

• Pale or dry and itchy skin.

• Bad breath.

• Hearing problems.

• Stomach mass.

• Tissue swelling, especially in the hands and legs.

• Irritability.

• Poor skin and muscle tone.

• Loose focus or concentration or a lot of confusion.

What Are the Diagnostic Methods for Renal Failure?

In addition, to complete medical and physical examinations, there are few investigations to diagnose renal failure.

• Blood Tests: A complete blood picture must determine blood cell and electrolyte values and kidney function.

• Urine Tests: Routine urine tests have to be done.

• Bone Scan: A nuclear imaging method to find any degenerative arthritic changes in the joints, detect bone diseases and tumors, to determine the cause of bone pain or inflammation.

• Renal Ultrasound: Renal ultrasound is a non-invasive investigation done to determine the swelling of the kidney, to find out the mass or tumor or cysts, and to determine the cause of obstruction.

How to Manage Acute Renal Failure in Children?

Treatment of child renal failure depends on a few factors, such as:

• Age of the child.

• Overall health and well-being of the child.

• The extent of the disease.

• Type of the failure, whether it is acute or chronic.

Diuretic therapy to increase urine output and Intravenous administration of fluids. Continuous monitoring of electrolytes such as sodium, potassium, and calcium has to be done. Use medications to treat underlying conditions such as diabetes and blood pressure. Chronic renal failure requires dialysis and renal transplantation. Kidney failure is often treated with a kidney transplant in children. Sometimes children a kidney transplant is done before dialysis is initiated. This is known as preemptive transplant. On the contrary some children take dialysis treatment to stay healthy before a transplant.

Conclusion

Acute renal failure is a condition caused by sudden onset, which may result in abnormal functioning of the kidney either temporarily or permanently. Acute renal failure is reversible in which the kidney may function normally, but if untreated, the acute kidney failure progresses into chronic renal failure and leads to various complications.