Question

Compare and contrast the causes, complications, and management of acute and chronic renal failure in children.

Answer 1

Ans) Acute kidney failure occurs suddenly and is often reversible. With treatment, kidney function may return to normal. Chronic kidney failure develops over a long period and is generally not reversible. Once the disease has progressed and kidney function is down to 10% - 15%, dialysis is usually require.

Kidney problems can develop suddenly (acute) or over the long term (chronic). Many conditions, diseases, and medicines can create situations that lead to acute and chronic kidney problems. Acute kidney injury, which used to be called acute renal failure, is more commonly reversible than chronic kidney failure.

Acute kidney injury (AKI) is usually caused by an event that leads to kidney malfunction, such as dehydration, blood loss from major surgery or injury, or the use of medicines.
Chronic kidney disease (CKD) is usually caused by a long-term disease, such as high blood pressure or diabetes, that slowly damages the kidneys and reduces their function over time.
The presence or lack of symptoms may help your doctor determine whether acute kidney injury or chronic kidney disease is present.

An acute kidney injury may also occur if your child:

takes certain medications that may be toxic to the kidneys
injures her abdomen or back, like a bike-riding accident that results in a fall over the handlebars, or a skiing accident
develops a sudden obstruction or blockage in her urinary tract, such as a kidney stone, that prevents urine from leaving the body
contracts an infection such as hemolytic uremic syndrome (HUS), usually caused by the E. coli bacteria, resulting in the blockage of the structures and blood vessels in the kidney
is born with blood vessel abnormalities that cut off blood flow to the kidneys
has another disease or condition that damages the kidneys, such as glomerulonephritis or lupus.

In infants and children: Birth defects, congenital abnormalities, and hereditary diseases, like polycystic kidney disease, are the most common causes of CKD. Frequent urinary tract infections (UTIs) in children should be promptly treated and further evaluated, as urinary tract abnormalities could potentially lead to CKD.

Symptoms of decreased kidney function, such as fluid buildup or electrolyte imbalance, are more likely to develop with acute kidney injury, regardless of how long the kidney has been malfunctioning. Symptoms may reflect the actual cause of the kidney problem.
An obstruction in the urinary tract may cause pain in the side or lower back (flank pain), blood in the urine, or reduced urine output.
Dehydration may cause extreme thirst; light-headedness or faintness; a weak, rapid pulse; and other symptoms.
- Symptoms of chronic kidney disease may not develop until very little kidney function remains. Other problems may develop with chronic kidney disease, such as anemia and increased levels of phosphorus in the blood (hyperphosphatemia), along with complications caused by kidney failure. These complications often do not develop until kidney disease has been present for some time.

- As CKD progresses, symptoms in children may include:

Swelling and/or puffiness around the eyes, feet, and ankles
Frequent urination or, in children 5 years or older, prolonged bedwetting
Stunted or poor growth, as compared to similar age group peers
Loss of appetite and chronic nausea
Fatigue
Frequent severe headaches from high blood pressure
Anemia and pallor from decreased red blood cell production

Management:

- Appropriate fluid management is also critical and the restoration of adequate blood volume is a priority in the early management of AKI.

- Kidney failure—described as end-stage kidney disease or ESRD when treated with a kidney transplant or blood-filtering treatments called dialysis—means the kidneys no longer work well enough to do their job. In most cases, kidney failure in children is treated with a kidney transplant. Though some children receive a kidney transplant before their kidneys fail completely, many children begin with dialysis to stay healthy until they can have a transplant.