The Development of CRRT for Infants and Children

Abstract

Acute kidney injury (AKI), or acute renal failure (ARF), in infancy may result from a variety of pathophysiologic events and is characterized by a sudden impairment of renal function with consequent decrease in urine output (<1 mL/kg/h in the newborn) and a parallel increase in blood levels of urea nitrogen, creatinine, and other waste products [1–3].The main cause of AKI/ARF in infancy is renal hypoperfusion due to acute volume depletion, perinatal asphyxia, severe hypotension and/or septic shock. Another frequent cause of AKI in children is acute tubular necrosis (ATN) associated with abdominal or cardiac surgery. Fluid and electrolyte imbalances are frequently present, and metabolic acidosis is often associated with other alterations of intermediary metabolism. All these pathologic conditions are aggravated in children by the small size of the patient and the limited tolerance of homeostatic imbalances. For these reasons, this disorder represents a severe illness in children, and it may become even more severe when it occurs in neonates, especially premature infants.