Acute and chronic renal failure in children: causes, symptoms, diagnosis, treatment

The child has such a serious pathology, as kidney failure, is rare. Nevertheless, for children it is much more dangerous than for adults, and can rapidly progress. It is worth knowing the possible causes and symptoms of the disease in order to prevent consequences in time.

Renal insufficiency in children

Disease in childhood can be acute and chronic. Under acute renal failure( ARF) is understood as a syndrome that occurs during a sharp decline in kidney function. It is based on oxygen starvation of kidney tissue, tubular damage and the occurrence of edema. Kidneys in this severe pathology lose the ability to secrete fluid, an acute imbalance of electrolytes and salts arises in the body. Another name for acute renal failure is acute uraemia.

This syndrome is characterized by the accumulation of nitrogen exchange products in the body, which disrupts many types of metabolism, leads to increased pressure, anemia and changes in the activity of most organs. The diagnosis of chronic renal failure is raised if the decrease in renal function lasts more than 3 months.

Renal failure can occur at any age, because there are many reasons for it. Sometimes it is recorded even in the fetus, for example, with intrauterine hypoxia. Previously, the percentage of surviving children after acute renal failure was very low, now the mortality rate has dropped to 20%( in newborns, mortality is still high - up to 50-75%).The frequency of ARF in children under 5 years - 4 cases per 100 thousand, of which 30% - children under one year. At school age, no more than 1 case of arresters is registered for the same number of people. Statistics of CRF in children is as follows - 10-50 cases per 1 million population.

Pathogenesis of

Acute kidney failure progresses according to the following stages:

1. Preaduric. Pathogenic factors begin to affect the tissues of the kidneys, the organs lose their basic functions.
2. Anuric. In the body, slags and exchange products, mineral salts, water are retained. The acid-base balance shifts towards oxidation( acidosis).There is acute poisoning of the body with ammonia and other metabolites.
3. Polyurethane. Diuresis gradually improves, but polyuria develops - an increase in the amount of excreted urine.
4. Restore. Kidneys restore their work, the permeability of the glomerular capillaries normalizes.

Chronic renal failure, regardless of the cause, is due to a decrease in the number of active nephrons( kidney cells).They are replaced with a connective tissue with the course of the disease. Load on the remaining nephrons increases - the mechanism of adaptation is included. This causes hypertrophy of nephrons, a violation of their structure and further progression of CRF.As a result, many kinds of metabolism change pathologically, the organism is in a state of intoxication.

Reasons for

ARF can exist in two forms:

• Organic( associated with damage to kidney tissue, leads to accumulation of nitrogen exchange products in the blood, disrupts electrolyte balance).
• Functional( it develops against the background of already existing water-salt exchange failure or disturbance of blood flow, respiration, is often reversible).

Functional renal failure is characteristic for severe poisoning, DIC syndrome( sharp increase in blood coagulability), intoxication, dehydration, oxygen starvation. Such conditions reduce the flow of blood to the kidney glomeruli, inside the kidneys, too, greatly reduces blood flow. This causes the death of nephrons with the development of APN phenomena.

Both organic and functional kidney failure in children can provoke such conditions:

1. In children of the first weeks of life - lung pathology, sepsis, intrauterine infections, hypoxia and suffocation in childbirth, necrosis of kidneys due to transfusion of incompatible blood, burn disease, vein vein thrombosis.
2. In children under 3 years - infectious intoxications, shock conditions, hemolytic-uremic syndrome.
3. Preschool children - lesions of kidney tissue with microbes and viruses, sepsis, trauma, poisoning.
4. Schoolchildren have systemic autoimmune diseases, glomerulonephritis.

OPN occurs against the background of congenital organic lesions of the kidneys - polycystosis, anomalies of development, but its share in the overall structure of morbidity is low.

The following pathologies can also aggravate uremia in children:

• Pyelonephritis;
• Glomerulonephritis;
• Nephropathy;
• Hemorrhagic vasculitis and other systemic autoimmune diseases;
• Diabetes;
• Amyloidosis of the kidney;
• Tuberculosis.

From congenital diseases that eventually lead to the development of CRF, we can name polycystosis, kidney hypoplasia, congenital hydronephrosis, calcification of the kidney, various hereditary nephropathies, etc. Any disease causes a gradual decrease in the parameters of glomerular filtration. Without a kidney transplant, many kinds of congenital pathologies quickly lead to the terminal stage of CRF.

Clinical picture

Symptoms of acute renal failure are layered on the signs of the disease, which triggered kidney damage. The first sign is always the decrease in the amount of urine( oliguria).She progresses, often reaches anuria - complete absence of urine.

Without treatment an anuric stage can reach 2 weeks, for this period such signs are joined:

• Paleness or yellowness of the skin.
• Bruising, rashes on the body.
• Weakness.
• Inhibition.
• Fainting.
• Swelling of the feet, face.
• Smell of ammonia from the mouth.
• Enhanced heart rate.
• Shortness of breath.
• Abdominal pain.
• Convulsions.
• Nausea, vomiting.
• Diarrhea.

All these signs are associated with an increasing intoxication of the body, because the kidneys do not cope with their filtration function. In children under one year on the background of insufficient kidney work, blood pressure rises. With proper treatment and, in particular, when eliminating the cause of acute renal failure, kidney function improves.

CRF causes the same consequences, only the duration of its development will be higher.

The disease progresses in stages with the following symptoms:

1. Latent stage. High fatigue, weakness, dry mouth.
2. Compensated stage. Decrease in daily diuresis, worsening of biochemical parameters of blood( symptoms are associated with increased death of nephrons).
3. Intermittent stage. Strong thirst, loss of appetite, nausea, vomiting, unpleasant taste in the mouth, dryness and flabbiness of the skin, loss of muscle tone. At this stage, all infectious diseases take place on an order of magnitude heavier.
4. Terminal stage. Apathy, which is followed by periods of overexcitation, insomnia, inadequate behavior, pressure and temperature decrease, bloating, vomiting, sweat odor, myocardial dystrophy, green diarrhea. Without kidney transplantation or dialysis, the disease at this stage leads to death.

Diagnosis

The basis of the diagnosis in ARF are a sharp decrease in diuresis and other acute symptoms described above and rapidly increasing. Mandatory blood tests are performed.

In the urine are revealed:

• Decrease in density, osmolarity.
• Growth of creatinine, urea.
• Increase the amount of sodium.
• Presence of cylinders, leukocytes.

In the blood, the amount of creatinine increases sharply, the glomerular filtration rates are reduced to 25%.Potassium is reduced to 7 mmol / l and lower. In addition, a number of functional tests, ultrasound or MRI of the kidneys, ureters, bladder, if necessary - cystoscopy, radiography.

The diagnosis of chronic kidney failure is based on an anamnesis in which there is a chronic disease of the urinary system. In blood tests in children of any age, a decrease in hemoglobin, leukocytosis, a drop in the level of glomerular filtration, an increase in potassium is detected. When carrying out the ECG, tachycardia, systolic noises, widening of the heart borders( symptoms of hyperkalemia) are revealed. Arterial hypertension is detected.

Differentiate kidney failure with:

• Encephalopathy.
• Acute glomerulonephritis.

Treatment of

Therapy of OPN should be started as soon as possible. The goals are to restore the volume of circulating blood, improve microcirculation of blood in the kidney tissue, detoxify the body.

In the early stages of the disease, an excellent effect is provided by the introduction:

• Drugs for the dilution of blood.
• Vasodilators.
• Diuretics.
• Drugs as part of anti-shock therapy.

Many small patients under one year with ARF are urgently required for hemodialysis on a special device. Without dialysis, it is impossible to save a patient with complications - hyperkalemia, pulmonary edema and brain, high blood pressure. Babies up to 6 months and newborns are more likely to be recommended peritoneal dialysis( peritoneal washing in continuous mode).

Chronic renal failure in children requires correction of the activity of many organs and systems.

With the development of CRF prescribe such drugs( as indicated):

• Calcium and vitamin D preparations to prevent calcium metabolism disorders.
• Antacids for reducing the level of phosphorus in the blood.
• Diuretics for increasing diuresis.
• Drugs from high pressure at its elevated level.
• Iron preparations for anemia.

If the symptoms of uremia increase, the child is treated with hemodialysis. After the stabilization of the condition of children up to 3-10 years old, they are again often transferred to conservative therapy. Good results are given by blood plasma plasmapheresis courses. Kidney transplantation usually allows the child to achieve a stable remission for many years.

Clinical recommendations

The amount of fluid consumed per day for a child is determined only by a doctor, based on blood and urine indicators. Breast children are given mother's milk, adapted mixtures. Children after one year without fail are prescribed a diet with strict restriction of salt and protein. The potato-egg-vegetable diet is preferred. In acute renal failure, fish, meat, and salt are completely excluded. The necessary set of amino acids should be given to children from special preparations.

Prognosis and possible complications of

In ARF, death can occur from a number of severe complications. In particular, hyperkalemia is dangerous - it often results in cardiac arrest. Complications of OPN can be uremic coma, sepsis, multiple organ failure. The prognosis depends on the cause of the pathology and speed of medical care. In 35% of surviving newborns, chronic renal failure and other kidney diseases, including kidney lag in growth, occur. In older children, more than 75% of survivors have a good prognosis - the function of the organs is restored.

Latent and compensated stages of chronic renal failure, subject to regular courses of treatment and compliance with the diet, have a favorable prognosis, possibly recovery, especially if the underlying pathology is corrected. At the intermittent stage, complete recovery is not possible, but life can be saved by dialysis for a long time. Even in the terminal stage, hemodialysis allows you to live at least 10 years. Kidney transplantation gives the sick child a chance for a long and fulfilling life in 50-80% of cases.