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ACUTE RENAL FAILURE in children : Summary



ACUTE RENAL FAILURE
Sudden reduction in renal function (oliguria / anuria with urine output < 1ml/kg/hr) with azotemia (raised s/creatinine)

Evaluation

  • History of anunia, oliguria, hematuria, dysuria, throat / skin infection, drug intake, vomiting / diarrhea, burns
  • Dehydration, puffy face, edema, ascites, effusion
  • Vital signs T,P,R,BP.
  • Visceromegaly : Liver, Kidney, bladder,
  • signs of heart failure
  • Funduscopy along with signs of CNS involvement

Investigation:

  • CBC, ESR
  • S/Na, K+, Urea, creatinine
  • Ca, P, ASOT, C3, ABG
  • Urine examination + c/s
  • ABD USG esp KUB areas
  • CXR, ECG for K+

Management
  • Pass IV line
  • Flow sheet:
  • T, P, R, B.P, strict Intake / output record  
  • Conscious level assessment
  • If anunia / shock, give 20 ml / kg N/saline or Ringer lactate rapidly over ½ hr, then assess.
  • Watch for passage of urine
  • Give 90 ml/kg N/Saline in 3 hrs, again review progress.
  • In case of persistent oliguria / anuria and normal BR, give Furosemide IV 2 mg/kg. If no improvement, repeat furosemide 4 mg/kg within 2 hrs.
  • If hypertension exists, give antihypertensives Nifedifine 0.2 – 0.5 mg / kg/dose or Labetolol / Captopril. If hypertensive encephalopathy, Sublingual
  • Nifedifine or Apresoline 0.5—1.5 mg / kg / day
  • Fluid is restricted in established renal failure with only 400 ml/M2/24 hr + Urine / Stool output.
  • Give 300 Cal/M2/day as Glucose solution (10%)                                         
  • Watch for hyperkalemia (prolonged PR interval, ST wave changes, peak T-Wave, wide QRS). Manage with following measures : 
  • Give Calcium Gluconate (10%) 1-2ml/kg slow, dilute with cardiac monitoring
  • Inj. NAHCO3 1-2 ml/kg
  • Nebulized Ventolin
  • Glucose 0.5-1 gm/kg followed by 0.1/unit insulin/kg
  • Kayexalate ion exchange resins like Na/Polystyrene sulfonate
  • Acidosis: Do ABG, calculate base deficit, give bicarb
  • Treat hyperphosphatemia  with Aluminium hydroxide gel 1ml/kg/d orally with food.
  • Antibiotics. (give Penicillin in poststreptococcal AGN, treat UTI appropriately.)

  • Peritoneal Dialysis indications :
Uncontrolled fluid overload, uncontrolled hyperkalemia, resistant metabolic acidosis, Encephalopathy, pericarditis, uncontrolled azotemia


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