Kidney Failure

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

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

  • Acute Kidney Failure
    • Decreased blood flow to the kidneys for a period of time. This may occur from blood loss or shock.
    • An obstruction or blockage along the urinary tract.
    • 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.
    • Ingestion of certain medications that may cause toxicity to the kidneys.
    • Glomerulonephritis - a type of kidney disease that involves glomeruli. During glomerulonephritis, the glomeruli become inflamed and impair the kidney's ability to filter urine.
    • Any condition that may impair the flow of oxygen and blood to the kidneys such as cardiac arrest.
  • Chronic Kidney Failure
    • A prolonged urinary tract obstruction or blockage.
    • Alport syndrome - an inherited disorder that causes deafness, progressive kidney damage, and eye defects.
    • 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.
    • Polycystic kidney disease - a genetic disorder characterized by the growth of numerous cysts filled with fluid in the kidneys.
    • Cystinosis - an inherited disorder whereby the kidneys have excessive excretion or certain amino acids. This leads to severe kidney stones
What are the symptoms of kidney failure?
The symptoms for acute and chronic kidney failure may be different. The following are the most common symptoms of acute and chronic kidney failure. However, each child may experience symptoms differently. Symptoms may include:
(Symptoms of acute kidney failure depend largely on the underlying cause.)
  • hemorrhage
  • fever
  • rash
  • bloody diarrhea
  • severe vomiting
  • abdominal pain
  • 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
  • exposure to heavy metals or toxic solvents
  • 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 kidney failure may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.
How is kidney failure diagnosed?
In addition to a physical examination and complete medical history, your child's physician may order the following diagnostic tests:
  • 7 blood tests - to determine blood cell counts, electrolyte levels, and kidney function
  • 7 urine tests - to measure waste materials rid from the body as well as body chemical changes.
  • 7 chest x-ray - a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • 7 bone scan - a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation.
  • 7 renal ultrasound (Also called sonography.) - a non-invasive 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.
  • 7 electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), detects heart muscle damage, and can demonstrate dangerous accumulations of toxic materials.
  • 7 renal biopsy - a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope.
Treatment for acute and chronic kidney failure:
Specific treatment for kidney failure will be determined by your child's physician 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 kidney 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 (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 kidney failure depends on the degree of kidney function that remains. Treatment may include:

  • medications (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 kidney failure are followed by a pediatrician and a nephrologist (a physician who specializes in disorders or diseases of the kidneys

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