Therapy For Acute Renal Failure Research Articles

High Volume Peritoneal Dialysis for Acute Renal Failure

Peritoneal dialysis (PD) is still widely used for acute renal failure (ARF) in developing countries despite concerns about its inadequacy. Continuous PD has been evaluated in ARF by analyzing the resolution of metabolic abnormality and normalization of plasma pH, bicarbonate, and potassium. A prospective study was performed on 30 ARF patients who were assigned to high-dose continuous PD (Kt/V = 0.65 per session) via a flexible catheter (Tenckhoff) and automated PD with a cycler. Fluid removal, pH and metabolic control, protein loss, and patient outcome were evaluated. Patients received 236 continuous PD sessions; 76% were admitted to ICUs. APACHE II score was 32.2+/-8.65. BUN concentrations stabilized after 3 sessions, creatinine after 4, and bicarbonate and pH after 2. Fluid removal was 2.1+/-0.62 L/day. Creatinine and urea clearances were 15.8+/-4.16 and 17.3+/-5.01 mL/minute respectively. Normalized creatinine clearance and urea Kt/V values were 110.6+/-22.5 L/week/1.73 m(2) body surface area and 3.8+/-0.6 respectively. Solute reduction index was 41%+/-6.5% per session. Serum albumin values remained stable in spite of considerable protein losses (median 21.7 g/day, interquartile range 9.1-29.8 g/day). Regarding ARF outcome, 23% of patients presented renal function recovery, 13% remained on dialysis after 30 days of follow-up, and 57% died. High-dose continuous PD by flexible catheter and cycler was an effective treatment for ARF. It provided high solute removal, allowing appropriate metabolic and pH control, and adequate dialysis dose and fluid removal. Continuous PD can therefore be considered an alternative to other forms of renal replacement therapy in ARF.

Renal Replacement Therapy in Acute Renal Failure: Which Index is Best for Dialysis dose Quantification?

The "delivered dose" of dialysis may significantly affect the outcome of acute renal failure (ARF) patients requiring dialysis. Our study aimed to elucidate which dose quantification method offers an appropriate parameter to compare different treatments in ARF patients. Six sustained low-efficiency daily dialysis (SLEDD), and 7 continuous venovenous hemofiltration (CVVH) patients with a prescribed Kt/V of 1.0 were studied during a single treatment. CVVH was studied over the first 24 hours after initiation. SLEDD was performed for 6-12 h. Solute clearance (K) was determined by direct dialysate quantification (DDQ). The single-pool Kt/V (spKt/V), equilibrated Kt/V (eqKt/V), equivalent renal urea clearance (EKRc), and solute removal index (SRI) were calculated. There were no significant differences at enrollment between the SLEDD and the CVVH groups in any patient characteristics except for the serum creatinine levels. The prescribed Kt/V of both groups was similar (SLEDD, 0.9+/-0.22; CVVH, 1.10+/-0.12, p=NS). The EKRc, which is used to verify kinetic equivalence among patients treated with differing renal replacement therapies (RRT), was higher in CVVH (15.7 in SLEDD; 27.4 in CVVH, p<0.0001), despite the fact that there was no difference between the delivered spKt/V for the SLEDD (1.05+/-0.40) and the CVVH (1.10+/-0.11) groups. The values for SRIurea (0.61 in SLEDD; 1.04 in CVVH, p=0.001), SRIcreatinine (0.55 in SLED; 1.02 in CVVH, p<0.0001), and SRIphosphate (1.81 in SLED; 3.60 in CVVH, p=0.03) were higher in CVVH. The EKRc is calculated assuming a steady state, which is an incorrect assumption in ARF patients with hypercatabolism. The SRI calculated using direct dialysate effluent quantification appears to be more reliable as an index of the dialysis dose compared to other methods in ARF patients. However, the use of the dialysate-side SRI is limited by the difficulty of dialysate effluent collection.

The use of peritoneal dialysis in newborns

Acute renal failure is a common complication in critically ill newborn infants. The therapy of acute renal failure is conservative and etiological. Patients not responding to this kind of therapy require peritoneal dialysis. This retrospective study included 6 newborn infants undergoing peritoneal dialysis during the period from January 2004 to June 2006, at the Nephrology Department of the Institute of Child and Youth Health Care in Novi Sad. All patients presented with complications of acute renal failure including hypercalemia and uremic encephalopathy. Complete restoration of kidney function was evident in four patients on peritoneal dialysis. Three patients are still alive, but in one patient acute renal failure progressed to chronic renal failure. One patient died in the third month of life due to multiple organ dysfunction, after just two days of dialysis. Several complications were reported: intra-abdominal hemorrhage, dialysate leakage, peritonitis and dialysis catheter obstruction. Periotoneal dialysis catheter placement is a great problem due to the size of the newborn. If it is estimated that it will be a long-lasting dialysis, Tenckhoff catheter is recommended. In very low birth weight newborn infants, in poor overall condition, general anesthesia is too risky, and acute peritoneal dialysis catheter should be placed (i.v. cannula, venous catheter). Peritoneal dialysis is the method of choice in newborns with acute renal failure, and it is used in the treatment of neonatal asphyxia till the restoration of kidney function is achieved.

Fractional excretion of urea in the follow-up of acute renal failure due to prerenal azotemia

Fractional excretion of urea (FEU) is a major issue to discriminate between prerenal azotemia and acute tubular necrosis in acute renal failure (ARF). Its role in the course of ARF remains unclear. The aim of this study was to evaluate FEU in the follow-up of ARF due to prerenal azotemia in order to predict the necessity of renal replacement therapy (RRT). The prospective study took place at the ICU of Stadtspital Waid, Zurich. All patients admitted starting from 19 February 2006 were evaluated for ARF according to the RIFLE classification. ARF due to prerenal azotemia was defined as ARF combined with FEU of less than or equal to 35%. FEU was calculated as [(urine urea/blood urea)/(urine creatinine/plasma creatinine)] × 100. Urine specimens were taken and FEU was calculated daily until complete or partial renal recovery was reached or the criteria for RRT were met. The goal of therapy was reconstitution of renal function by treatment of the underlying condition. RRT was initiated according to the usual criteria. Statistics were determined using Fisher's exact test. By 7 December 2006, 15 patients met the inclusion criteria for ARF due to prerenal azotemia (nine males, six females). The mean age was 71 ± 11 (SD) years for male patients and 58 ± 31 years for female patients. Twelve out of the 15 patients responded to conservative management and had complete or partial renal recovery. Three patients needed RRT. Two of them refused RRT and died during the course of the disease. During the first 48 hours after initiation of conservative therapy, FEU remains less than or equal to 35% in all three patients who needed RRT. By contrast, nine out of 12 patients in whom renal function recovered without RRT showed a FEU of more than 35% within the first 48 hours (P < 0.05) (Figure ​(Figure11). Figure 1 Fractional excretion of urea (FEU) in the follow-up of acute renal failure (ARF) due to prerenal azotemia. Data presented as mean ± SD. n = number of patients. In patients presenting with ARF due to prerenal azotemia, an increase of FEU above 35% within the first 48 hours after initiation of conservative therapy for ARF is a valuable parameter to predict renal recovery. After initiation of conservative therapy, measurement of FEU is of no value concerning discrimination of prerenal azotemia and acute tubular necrosis in ARF.

Current worldwide practice of dialysis dose prescription in acute renal failure

The practice of renal replacement therapy for acute renal failure varies greatly around the world. This is especially true for the dose of renal replacement therapy. This review describes the epidemiology of dialysis prescription and delivery around the world based on recent observational studies and international surveys. Furthermore, a brief speculation on the concept of adequacy of therapy is provided. Following the publication of the first large prospective randomized trial on the effects of treatment dose on outcome of patients with acute renal failure a certain consensus has been achieved on the adequacy of 35 ml/kg/h of clearance in continuous therapies. Surveys conducted in 1998 had demonstrated that such adequate therapy was only prescribed in a minority of patients. Recent observations based on questionnaires and surveys confirm that the number of centers prescribing adequate dialysis dose is increasing, but there is still a large number of institutions where prescription is made with no specific adequacy targets and effective delivery is not measured. Several barriers have been identified to reach adequacy targets including logistics, costs, personnel and others. The analysis of the epidemiology of dialysis dose around the world shows a complex picture. Wide variations in practice are present although a significant effort has been made to standardize the prescription and delivery of therapy.

Catheter Colonization in Acute Renal Failure Patients: Comparison of Central Venous and Dialysis Catheters

Little is known about vascular access infections in patients with acute renal failure. We prospectively compared infection rates of dialysis catheters (DCs) and central venous catheters (CVCs) in patients in the intensive care unit treated with renal replacement therapy for acute renal failure. The same insertion and maintenance procedures were used for CVCs and DCs. To circumvent the allocation bias caused by severity of patient condition, only patients with both types of catheters were included. A total of 150 CVCs and 130 DCs were analyzed in 99 patients with a mean Simplified Acute Physiology Score II of 67 +/- 21. The major cause of acute renal failure was sepsis (62%). Hospital mortality was 62%. Mean catheter duration was shorter for DCs (6.7 +/- 4.4 days) than CVCs (7.8 +/- 4.9 days; P = 0.03). There was no difference between CVCs and DCs in cumulative incidence of catheter colonization (quantitative catheter cultures > or = 10(3) colony-forming units/mL; 4.7% versus 6.2%; P = 0.58) or incidence density of catheter colonization per 1,000 catheter days (5.9 versus 9.1; P = 0.44, respectively). There also was no difference between CVCs and DCs in cumulative incidence and incidence density regardless of whether catheters were placed at the internal jugular (P = 0.34 and P = 0.23) or femoral site (P = 0.57 and P = 0.80), respectively. Three cases of CVC-related bacteremia (the same microorganism responsible for both catheter colonization and blood culture result) were recorded, but none with DC use. When severity of patient condition is controlled for, epidemiological characteristics of colonization in CVCs and DCs are similar if similar infection control measures are used for insertion and maintenance.

Stem Cells in Kidney Regeneration Following Acute Renal Injury

Acute renal failure has 50-80% mortality. Currently, treatment options for this life-threatening disease are limited. Stem cells offer an exciting potential for kidney regeneration. This review discusses pathogenesis of acute renal failure resulting from ischemia-reperfusion injury and the role of stem cells in reversing or mitigating this disorder. Specifically, the issues of differentiation of kidney cells from embryonic stem cells and bone marrow stem cells, and whether adult kidney stem/progenitor cells exist in the postnatal kidney are discussed. Evidence to support the conclusion that intra-renal cells, including surviving tubular epithelial cells and potential renal stem/progenitor cells, are the main source for renal regeneration is provided. Future research in selecting the type(s) of stem cells and optimizing the dose, frequency and route of administration of the cells will be fundamental in successful cell replacement therapy in acute renal failure. Methods for enhancing endogenous renal cell proliferation and differentiation for renal repair continue to be important research directions.

Induction of Zf9 in the kidney following early ischemia/reperfusion

An improved understanding of the early cell injury mechanisms is critical for effective therapy of acute renal failure (ARF). We utilized cDNA microarrays to identify renal genes that are induced very early after renal ischemia in a mouse model, whose protein products might provide novel information regarding the pathogenesis of ARF. The findings were confirmed by downstream mRNA and protein expression studies, as well as knockdown analysis with antisense primers. The maximally induced gene (21-fold at 3 hours of reflow) was Zf9, a Kruppel-like transcription factor involved in the regulation of transforming growth factor-beta1 (TGF-beta1). The rapid induction of Zf9 mRNA was confirmed by Northern analysis (14.5-fold at 3 hours of reflow) and that of Zf9 protein by Western analysis (10.5-fold at 3 hours of reflow). Zf9 protein was induced in both proximal and distal tubule cells in a cytoplasmic as well as nuclear distribution. TGF-beta1 protein was also up-regulated in a pattern parallel to that of Zf9. In cultured human proximal tubule cells, induction of ischemia by partial adenosine triphosphate (ATP) depletion resulted in a rapid up-regulation of both Zf9 and of TGF-beta1 proteins. Antisense oligonucleotides to Zf9 markedly blunted the induction of Zf9 and TGF-beta1, and significantly inhibited the apoptotic response to ATP depletion. Induction of Zf9 and its transactivating factor TGF-beta1 may play a critical and hitherto unrecognized role in the early apoptotic response to ischemic renal injury.

Survival and quality of life of patients requiring acute renal replacement therapy

To assess long-term survival and health-related quality of life in patients with acute renal failure. Cross-sectional cohort study in the ten-bed medical-surgical intensive care unit and the three-bed acute dialysis unit in a tertiary care hospital. 703 patients receiving renal replacement therapy for acute renal failure during 1998-2002. The mortality rate was 41% at 28 days, 57% at 1 year, and 70% at 5 years. SOFA score, age, and continuous renal replacement therapy were independent predictors of 1-year mortality. The median follow-up time was 3.9 years for mortality and 2.4 years for health-related quality of life. Of the 229 survivors in 2003, 153 (67%) responded to the health-related quality of life questionnaire. Health-related quality of life was evaluated with the EuroQol (EQ-5D) instrument including a visual analogue scale (VAS) score to evaluate the patient's perceived health. The EQ-5D score was significantly lower in the study population than in the age- and gender-matched Finnish population (0.68 vs. 0.86). Median VAS scores were 69.5 and 70.0, respectively. Patients' age and duration of follow-up had no significant effect on EQ-5D or VAS scores. Mortality and EQ-5D data were used to calculate quality-adjusted life years. Quality-adjusted survival was poor (15 quality-adjusted life years per 100 patients in the first year of follow-up). The long-term survival of patients with acute renal failure is poor. Although survivors have a low health-related quality of life, they are as satisfied with their health as the general population.

Renal Replacement Therapies for Acute Renal Failure: Does Dose Matter?

21-YEAR-OLD man with no previous medical history presented to the emergency department 3 days after eing bitten in the left flank by a brown recluse spider. He eported fevers, chills, shortness of breath, hemoptysis, and ecreased urine output. He was febrile, hypotensive, and equired intubation for respiratory distress. Physical examiation was significant for an indurated and erythematous esion on his left flank. His weight was 73 kg. Before ntubation, arterial blood gas analysis showed a pH of 7.40, CO2 of 30 mm Hg, and PO2 of 58 mm Hg on 21% fraction of nspired oxygen. Sodium level was 130 mEq/L (mmol/L); otassium, 6.5 mEq/L (mmol/L); chloride, 101 mEq/L (mmol/ ); bicarbonate, 18 mEq/L (mmol/L); blood urea nitrogen, 6 mg/dL (16.4 mmol/L); creatinine, 3.4 mg/dL (301 mol/ ); glucose, 107 mg/dL (5.9 mmol/L); and lactic acid, 55 g/dL (6.1 mmol/L). Hematocrit was 22%, white blood cell ount was 20,000/ L, and platelet count was 107,000/ L. isseminated intravascular coagulation profile was remarkble for D-dimers of 1:32, fibrinogen of 114 mg/dL (3.4 mol/L), and international normalized ratio of 2.7. Urine nalysis was significant for 4 protein, 4 blood, coarse ranular casts, and no cells. Urine myoglobin was positive. he nephrology department was consulted, and a diagnosis f anuric acute tubular necrosis was made. The patient initially was started on intermittent hemodialyis (IHD) therapy for metabolic control and volume overload n the setting of anuric renal failure. However, after the first ialysis treatment, he developed hemodynamic instability nd was placed on continuous venovenous hemodiafiltration herapy using the Prisma machine with an M60 set with an N69 dialyzer (Gambro, Lakewood, CO) (effective surface rea, 0.6 m) and a blood flow rate of 120 mL/min. He was tarted empirically on a dialysate rate of 1,000 mL/h, prediutional replacement fluid rate of 300 mL/h, and fluid reoval rate of 200 mL/h, giving him a total effluent flow rate f 1,500 mL/h. Urea clearance was approximately 21 mL/ in/kg. He remained on this therapy for 3 months because f oligoanuria. During this period, his course was compliated by intra-abdominal compartment syndrome, enterocuaneous fistula, digital necrosis, pneumonia caused by seudomonas species, and other nosocomial infections. Depite this prolonged complicated hospital course and lengthy ialysis therapy, he recovered renal function, was extubated, nd eventually was transferred to a rehabilitation facility ith a creatinine level of 1.1 mg/dL (97 mol/L).

Prevention and therapy of acute renal failure

Prevention and therapy of acute renal failure

Comparison of continuous and intermittent renal replacement therapy for acute renal failure

Mortality rates of critically ill patients with acute renal failure (ARF) requiring renal replacement therapy (RRT) are high. Intermittent and continuous RRT are available for these patients on the intensive care units (ICUs). It is unknown which technique is superior with respect to patient outcome. We randomized 125 patients to treatment with either continuous venovenous haemodiafiltration (CVVHDF) or intermittent haemodialysis (IHD) from a total of 191 patients with ARF in a tertiary-care university hospital ICU. The primary end-point was ICU and in-hospital mortality, while recovery of renal function and hospital length of stay were secondary end-points. During 30 months, no patient escaped randomization for medical reasons. Sixty-six patients were not randomized for non-medical reasons. Of the 125 randomized patients, 70 were treated with CVVHDF and 55 with IHD. The two groups were comparable at the start of RRT with respect to age (62+/-15 vs 62+/-15 years, CVVHDF vs IHD), gender (66 vs 73% male sex), number of failed organ systems (2.4+/-1.5 vs 2.5+/-1.6), Simplified Acute Physiology Scores (57+/-17 vs 58+/-23), septicaemia (43 vs 51%), shock (59 vs 58%) or previous surgery (53 vs 45%). Mortality rates in the hospital (47 vs 51%, CVVHDF vs IHD, P = 0.72) or in the ICU (34 vs 38%, P = 0.71) were independent of the technique of RRT applied. Hospital length of stay in the survivors was comparable in patients on CVVHDF [median (range) 20 (6-71) days, n = 36] and in those on IHD [30 (2-89) days, n = 27, P = 0.25]. The duration of RRT required was the same in both groups. The present investigation provides no evidence for a survival benefit of continuous vs intermittent RRT in ICU patients with ARF.

Future strategies in the treatment of acute renal failure: growth factors, stem cells, and other novel therapies

Acute renal failure remains a significant cause of morbidity and mortality in adults and children. Despite advances in understanding the pathophysiology of acute renal failure, little progress has been made in its treatment. This review assesses the recent data on current and promising new therapies for acute renal failure. The first section of the review describes the recent therapies that have been used in humans, all of whom have been adults. The second section evaluates the use of agents given in experimental animal models during or after the onset of acute renal failure. The third section describes the many animal studies using therapies before the onset of experimental renal failure. The final section discusses how the emerging field of stem cell research might be used to treat acute renal failure. Among the recent studies in humans, the most intriguing have been the use of atrial natriuretic peptide in patients with nonoliguric renal failure and isotonic sodium bicarbonate infusions to prevent radiocontrast medium-induced renal failure. Among the agents used in animal studies, those with the greatest potential were hepatocyte growth factor and ethyl pyruvate, because they seem to protect against or accelerate recovery from acute renal failure after the renal insult. Finally, stem cell therapy may someday offer the best option for recovery from acute renal failure.

Outcome in critically ill medical patients treated with renal replacement therapy for acute renal failure: comparison between patients with and those without haematological malignancies

Starting renal replacement therapy (RRT) for acute renal failure in critically ill patients with haematological malignancies is controversial because of the poor outcome and high costs. The aim of this study was to compare the outcome between critically ill medical patients with and without haematological malignancies who received RRT for acute renal failure. We retrospectively collected data on all consecutive patients who received RRT for acute renal failure at the Medical Intensive Care Unit (ICU) of a University Hospital between 1997 and 2002, and assessed the impact of the presence of a haematological malignancy on the survival within 6 months after ICU admission by Cox proportional hazard models. Fifty of the 222 (22.5%) consecutive patients with haematological malignancies admitted to the ICU over the study period received RRT for acute renal failure compared with 248 of the 4293 (5.8%) patients without haematological malignancies (P<0.001). Among patients who received RRT, those with haematological malignancies had higher crude ICU (79.6 vs 55.7%, P=0.002) and in-hospital (83.7 vs 66.1%, P=0.016) mortality rates, and a higher mortality at 6 months (86 vs 72%, P=0.018) by Kaplan-Meier estimates compared with those without haematological malignancies. However, after adjustment for the severity of illness and the duration of hospitalization before ICU admission, haematological malignancy by itself was no longer associated with a higher risk of death (hazard ratio 1.04; 95% confidence interval, 0.73-1.54, P=0.78). Medical ICU patients with haematological malignancies have a higher rate of occurrence of acute renal failure treated with RRT and a higher mortality, compared with those without haematological malignancies. However, the presence of a haematological malignancy by itself is not a reason to withhold RRT in medical ICU patients with acute renal failure.

Torsemide Versus Furosemide After Continuous Renal Replacement Therapy Due to Acute Renal Failure in Cardiac Surgery Patients

Diuretic therapy in ARF (acute renal failure) is mainly done with loop diuretics, first of all furosemide. Torsemide has a longer duration of action and does not accumulate in renal failure. In chronic and acute renal failure, both diuretics have been effectively applied, with a more pronounced diuretic effect for torsemide. In this study, the effects of torsemide versus furosemide on renal function in cardiac surgery patients recovering from ARF after continuous renal replacement therapy (CRRT) were studied. Twenty-nine critically ill patients admitted to an intensive care unit at a university teaching hospital after cardiac surgery recovering from ARF after CRRT were included in this prospective, controlled, single-center, open-labeled, randomized clinical trial. Inclusion criteria were urine output > 0.5 mL/kg/h over 6 h under CRRT. Torsemide and furosemide dosages were adjusted with the target urine output being 0.8–1.5 mL/kg/h. Hemodynamic data, urine output, volume balance, serum creatinine clearance, electrolytes, blood urea nitrogen, serum creatinine, renin, and aldosterone concentrations were measured. Fourteen patients were included in the furosemide group and 15 patients in the torsemide group. Dosages of 29 (0–160) mg torsemide and a dosage of 60 (0–240) mg furosemide were given every 6 h in each group, respectively. The dosage given at the end of the study decreased significantly in furosemide and torsemide treated patients. Urine output, 24 h balance, and serum creatinine clearance did not differ significantly between groups. Urine output decreased in both groups, mostly dose-dependent in the torsemide group. The intragroup comparison of the first time-interval after inclusion with the last time-interval showed a significant increase in serum creatinine and blood urea nitrogen in the furosemide group. Renin and aldosterone concentrations did not show significant differences. In conclusion, torsemide and furosemide were effective in increasing urine output. Torsemide might show a better dose-dependent diuretic effect in ARF patients after CRRT treatment. Serum creatinine and blood urea nitrogen elimination were less pronounced in the furosemide group.

Renal replacement therapy for acute renal failure in the intensive care unit is associated with a worse prognosis than renal replacement therapy for end-stage renal failure

Renal replacement therapy for acute renal failure in the intensive care unit is associated with a worse prognosis than renal replacement therapy for end-stage renal failure

Convective renal replacement therapies for acute renal failure and end‐stage renal disease

Although hemodialysis remains the primary treatment modality for the management of patients with end-stage renal disease (ESRD), its clearance of relatively large-sized uremic toxins is limited due to its primarily diffusive nature. Moreover, recent studies suggesting conventional, diffusion-based therapies may be limited in their ability to influence outcome in ESRD patients indicate the need for alternative chronic dialysis approaches, an example of which is convective therapies. In an analogous manner, a reassessment of the dialytic management of critically ill patients with acute renal failure (ARF) has also occurred recently based on clinical evidence that high-dose continuous hemofiltration improves survival. These recent clinical results suggest the utilization of convective therapies in both ARF and ESRD will increase in the future. This article provides a review of convective therapies, with an initial discussion of the determinants of convective solute removal. This is followed by a comprehensive overview of the manner in which hemofiltration and hemodiafiltration are applied clinically.

Acute Renal Failure in the Newborn

Acute renal failure in the newborn is a common problem and is typically classified as prerenal, intrinsic renal disease including vascular insults, and obstructive uropathy. In the newborn, renal failure may have a prenatal onset in congenital diseases such as renal dysplasia with or without obstructive uropathy and in genetic diseases such as autosomal recessive polycystic kidney disease. Acute renal failure in the newborn is also commonly acquired in the postnatal period because of hypoxic ischemic injury and toxic insults. Nephrotoxic acute renal failure in newborns is usually associated with aminoglycoside antibiotics and nonsteroidal anti-inflammatory medications used to close a patent ductus arteriosis. Alterations in renal function occur in approximately 40% of premature newborns who have received indomethacin and such alterations are usually reversible. Renal artery thrombosis and renal vein thrombosis will result in renal failure if bilateral or if either occurs in a solitary kidney. Cortical necrosis is associated with hypoxic/ischemic insults due to perinatal anoxia, placenta abruption and twin-twin or twin-maternal transfusions with resultant activation of the coagulation cascade. As in older children, hospital acquired acute renal failure is newborns is frequently multifactorial in origin. Although the precise incidence and prevalence of acute renal failure in the newborn is unknown, several studies have shown that acute renal failure is common in the neonatal intensive care unit. Recent interesting studies have demonstrated that some newborns may have genetic risks factors for acute renal failure. Once intrinsic renal failure has become established, management of the metabolic complications of acute renal failure continues to involve appropriate management of fluid balance, electrolyte status, acid-base balance, nutrition and the initiation of renal replacement therapy when appropriate. Renal replacement therapy may be provided by peritoneal dialysis, intermittent hemodialysis, or hemofiltration with or without a dialysis circuit. The preferential use of hemofiltration by pediatric nephrologists is increasing while the use of peritoneal dialysis is decreasing except for neonates and small infants. Peritoneal dialysis has been a major modality of therapy for acute renal failure in the neonate when vascular access may be difficult to maintain. In the newborn, the prognosis and recovery from acute renal failure is highly dependent upon the underlying etiology of the acute renal failure. Factors that are associated with mortality include multiorgan failure, hypotension, need for pressors, hemodynamic instability, and need for mechanical ventilation and dialysis. The mortality and morbidity of newborns with acute renal failure is much worse in neonates with multiorgan failure. Newborns who have suffered substantial loss of nephrons as may occur in cortical necrosis are at risk for late development of renal failure after apparent recovery from the initial insult. Similarly, hypoxic/ischemic and nephrotoxic injury to the developing kidney can result is decreased nephron number. Newborns with acute renal failure need life-long monitoring of their renal function, blood pressure, and urinalysis. Typically, the late development of chronic renal failure will first becomes apparent with the development of hypertension, proteinuria, and eventually an elevated blood urea nitrogen and creatinine.

Outcome in critically ill medical patients requiring renal replacement therapy for acute renal failure: comparison between patients with and without hematologic malignancies

Outcome in critically ill medical patients requiring renal replacement therapy for acute renal failure: comparison between patients with and without hematologic malignancies

Renal Replacement Therapy in Acute Renal Failure

Artificial OrgansVolume 27, Issue 9 p. 753-754 Renal Replacement Therapy in Acute Renal Failure William R. Clark, William R. Clark NxStage Medical, Inc. Indiana University School of Medicine Indianapolis, IN, U.S.A. Search for more papers by this author William R. Clark, William R. Clark NxStage Medical, Inc. Indiana University School of Medicine Indianapolis, IN, U.S.A. Search for more papers by this author First published: 28 August 2003 https://doi.org/10.1046/j.1525-1594.2003.00992.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume27, Issue9September 2003Pages 753-754 RelatedInformation