increase, instead of a decrease, has been observed during the first week
of life. It is not until an adjusted conceptional age of 34 weeks that the
serum creatinine levels are comparable to those of term infants.[26]Initial management of renal failure
- Determine the cause of renal dysfunction
Patients with oliguria and rising plasma creatinine levels should
immediately be investigated. Urinary electrolytes and FENa, along with a
microscopic analysis of the urine may give some clues as to whether the renal
failure is pre-renal or renal. The physician should carefully review all medications
and determine the recent use of intravenous contrast agents.
Critically ill patients with severe sepsis often have ARF.
- Assess fluid deficit and correct hypovolemia
Hypotension, tachycardia and oliguria are clinical indicators of
hypovolemia. Prolonged hypovolemia could inevitably lead to ischemic damage
to the renal tubules with resultant injury. A central venous catheter (CVC) should
be placed to guide fluid management in patients with ARF associated with
oliguria. This important measure will prevent the development of pulmonary
edema secondary to aggressive fluid resuscitation or commonly generalized
edema. CVC allows the measurement of central venous pressure (CVP) and
central venous oxyhemoglobin saturation (ScvO 2 ).
Commonly, children with low circulatory volume and oliguria receive an initial
fluid bolus challenge of 10-20 mL/kg over 30 min and repeated until there is a
response. This measure is an acceptable step in the resuscitation process but
should be conducted carefully in the critically ill children, in which, fluid