Topics Discussed: kidney failure; renal failure, acute; urology and nephrology.
Excerpt:"Definition. In neonates, acute renal failure is defined as the absence of urinary output (anuria) or as urine output of <0.5 mL/kg/24 h (oliguria) with an associated increase in serum creatinine. One hundred percent of infants void by 24 h (for average times from birth to first voiding, see Table 61–1).
Incidence. In some studies, as many as 23% of neonates have some form of renal failure; prerenal factors are identified as the cause in 73%. In a recent study causes included cardiac (27%), prematurity (27%), septic (10%), hepatic (9%), renal (9%), and other (18%) causes. Twelve infants needed transient dialysis treatment.
Pathophysiology. Normal urine output is ~1–3 mL/kg/h in newborns. The normal newborn kidney has poor concentrating ability. Renal failure leads to problems with volume overload, hyperkalemia, acidosis, hyperphosphatemia, and hypocalcemia. Acute renal failure is traditionally divided into three categories:
- Prerenal failure. Prerenal failure is due to decreased renal perfusion. Causes include dehydration (poor feeding or increased insensible losses referable to radiant warmers), perinatal asphyxia, and hypotension (septic shock, hemorrhagic shock, or cardiogenic shock resulting from congestive heart failure).
- Intrinsic renal failure. If poor renal perfusion persists, acute..."
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