Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e
Chapter 128. Renal Emergencies in Infants and Children
Sections: Acute Renal Failure, End-Stage Renal Disease, Acute Glomerulonephritis, Nephrotic Syndrome, Renal Tubular Acidosis, Urolithiasis, Hypertension, Henoch-Schönlein Purpura, Hemolytic-Uremic Syndrome, Hematuria, References.
Topics Discussed: renal disorders.
Excerpt:"Acute renal failure is the sudden loss of renal function necessary
to maintain normal fluid and electrolyte balance and clear metabolic
waste.1,2 The most common causes of acute renal
failure in children are glomerulonephritis, sepsis, hemolytic uremic
syndrome (HUS), and postoperative complications. Taken as a whole,
the mortality of children with acute renal failure is reported in
the literature to range from 8% to 89% and varies
by cause.1Acute renal failure is the result of nephrotoxic and/or
hypoxic injury to the glomeruli and renal tubules. About 70% of
cases result from nephrotoxic insults and 30% from ischemia.1 Reduced
renal blood flow causes hypoxic injury and damages the proximal
tubular cells. Medications such as amoxicillin, acyclovir, gentamicin,
and cephalosporins also contribute to renal tubular injury. Inflammatory
mediators intensify renal tubular damage.2The presentation of acute renal failure is variable and depends on
the cause. Many symptoms and signs relate to the underlying disorder (e.g.,
bloody diarrhea in HUS), whereas symptoms of renal failure itself include
nausea and anorexia (secondary to uremia), changes in urine output..."
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