ACUTE RENAL FAILURE

Christine Horvat Davey

Overview

Acute renal failure (ARF), also known as acute kidney injury, is a reversible acute decline in renal function with rapid onset (Devarajan, 2017). ARF is marked by a decrease in the glomerular filtration rate, an inability of the kidneys to regulate fluid and electrolyte homeostasis as well as an increase in serum creatinine and blood urea nitrogen levels (Andreoli, 2009). The exact incidence of infant ARF is unknown. Nursing care for infants with ARF focuses on determination and treatment of the underlying cause with early medical management to decrease long-term sequelae.

Background

After birth, the kidneys undergo a maturation process and continue further to adapt, which is a vital element in the prevention and management of neonatal ARF (Nada, Bohachea, & Askenazi, 2017). The number of nephrons present at birth is attributed to the genetic and fetal environmental factors and range from 300,000 to 1.8 million per kidney (Nada et al., 2017). Premature infants with ARF can be at an increased risk of long-term kidney issues depending on the status of their nephrons (Nada et al., 2017). The incidence of ARF is rising in relation to the increased use of advanced medical technology for infants who are critically ill or experience chronic conditions (Devarajan, 2017).

ARF in infants is rarely caused by a primary renal issue, but rather by reversible prerenal failure owing to poor perfusion of kidneys, acute tubular necrosis, or cortical necrosis (Coulthard, 2016). Hypotension is the primary cause of poor perfusion and can be caused by cardiac failure, hypovolemia, vasodilation associated with sepsis, multiple organ failure, or a combination of these (Coulthard, 2016). There are several additional factors associated with an increased risk of the development of ARF in infants, including premature birth, birth weight, nephrotoxicity, genetics, hypoxia, ischemia, acute injury, or illness. Premature birth can lead to a low nephron count and incomplete nephrogenesis, contributing to an increased risk of the development of ARF. A low birth weight places infants at a higher risk of developing ARF (Arcinue, Kantak, & Elkhwad, 2015). Nephrotoxin-induced ARF is often related to hospitalization because hospitalization poses an increased risk of exposure to medications that are nephrotoxic (Sutherland et al., 2013). In addition to environmental factors, there may be genetic risk factors for ARF. Several candidate polymorphisms have shown an association with ARF (Andreoli, 2009).

The diagnosis of ARF is most often based on characteristic signs and symptoms: edema, decreased urine output, hematuria, and/or hypertension with abnormal laboratory results, especially abnormal serum creatinine levels. 118A normal serum creatinine level for an infant is 0.2 to 0.4 mg/dL (18–35 µmol/L; Devarajan, 2017). However, the diagnostic use of serum creatinine levels can present issues. Following ARF, serum creatinine is an insensitive and delayed measure of decreased kidney function (Andreoli, 2009). Serum creatinine may not increase until a 50% or higher reduction in the glomerular filtration rate is present (Devarajan, 2017

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