Overview of Renal Failure in Children :: Nationwide Children's Hospital

Overview of Renal Failure in Children

What is renal failure?

Renal failure refers to temporary or permanent damage to the kidneys that results in loss of normal kidney function. There are two different types of renal failure—acute and chronic. Acute renal failure has an abrupt onset and is potentially reversible. Chronic renal failure persisits over at least three months and can lead to progressive loss of kidney function. The causes, symptoms, treatments, and outcomes of acute and chronic kidney failure are variable and different.

Conditions that may lead to acute or chronic renal failure may include, but are not limited to, the following:

Acute renal failure (Acute Kidney Injury) Chronic renal failure (Chronic Kidney Disease)
Decreased blood flow to the kidneys for a period of time. This may occur from dehydration, blood loss, surgery, or shock. Abnormal development of the kidneys during pregnancy.
An obstruction or blockage along the urinary tract. A prolonged urinary tract obstruction or blockage.
Hemolytic uremic syndrome. Usually caused by an E. coli infection, kidney failure develops as a result of obstruction to the small functional structures and vessels inside the kidney.  Glomerulonephritis (see left)
Ingestion of certain medications that may cause damage to the kidneys.  Nephrotic syndrome. A condition that has several different causes. Nephrotic syndrome is characterized by protein in the urine, low protein in the blood, high cholesterol levels, and tissue swelling.
Glomerulonephritis. A type of kidney disease in which the kidney filters become inflamed and impair the kidney's ability to filter urine.  Polycystic kidney disease. A genetic disorder characterized by the growth of numerous cysts filled with fluid in the kidneys.
Any condition that may impair the flow of oxygen and blood to the kidneys, such as cardiac arrest. Recurrent kidney infections and urinary reflux.
  Certain genetic disorders

What are the symptoms of renal failure?

The symptoms for acute and chronic renal failure may be different. The following are the most common symptoms of acute and chronic renal failure. However, each child may experience symptoms differently.

Acute symptoms may include:
(Symptoms of acute renal failure depend largely on the underlying cause.)

  • Blood in urine
  • Fever
  • Rash
  • Bloody diarrhea
  • Severe vomiting
  • Headache
  • No urine output or high urine output
  • History of recent infection
  • Pale skin
  • History of taking certain medications
  • History of trauma
  • Swelling of the tissues
  • Inflammation of the eye
  • Detectable abdominal mass

Chronic symptoms may include:

  • Poor appetite
  • Vomiting
  • Bone pain
  • Headache
  • Stunted growth
  • Malaise
  • High urine output or no urine output
  • Recurrent urinary tract infections
  • Urinary incontinence
  • Pale skin
  • Bad breath
  • Hearing deficit
  • Detectable abdominal mass
  • Tissue swelling
  • Irritability
  • Poor muscle tone
  • Change in mental alertness

The symptoms of acute and chronic renal failure may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.

How is renal failure diagnosed?

In addition to a physical examination and complete medical history, your child's doctor may order the following diagnostic tests:

  • Blood tests. Blood tests will determine blood cell counts, electrolyte levels, and kidney function.
  • Urine tests
  • Chest X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Renal ultrasound (also called sonography). A noninvasive test in which a transducer is passed over the kidney producing sound waves which bounce off the kidney, transmitting a picture of the organ on a video screen. The test is used to determine the size and shape of the kidney, and to detect a mass, kidney stone, cyst, or other obstruction or abnormalities.
  • Electrocardiogram (ECG or EKG). This test records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
  • Renal biopsy. This procedure involves the removal of tissue samples (with a needle or during surgery) from the body for examination under a microscope.

What is the treatment for acute and chronic renal failure?

Specific treatment for renal failure will be determined by your child's doctor based on:

  • Your child's age, overall health, and medical history
  • The extent of the disease
  • The type of disease (acute or chronic)
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Treatment of acute renal failure depends on the underlying cause. Treatment may include:

  • Hospitalization
  • Administration of intravenous (IV) fluids in large volumes (to replace depleted blood volume)
  • Diuretic therapy or medications (to increase urine output)
  • Close monitoring of important electrolytes such as potassium, sodium, and calcium
  • Medications (e.g. to control blood pressure)
  • Specific diet requirements

In some cases, children may develop severe electrolyte disturbances and toxic levels of certain waste products normally eliminated by the kidneys. Children may also develop fluid overload. Dialysis may be indicated in these cases.

Treatment of chronic renal failure depends on the degree of kidney function that remains. Treatment may include:

  • Medications (e.g. to help with growth, prevent bone density loss, and/or to treat anemia)
  • Diuretic therapy or medications (to increase urine output)
  • Specific diet restrictions
  • Dialysis
  • Kidney transplantation

Most children with renal failure are followed by a pediatrician and a nephrologist (a doctor who specializes in disorders or diseases of the kidneys).

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