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The following guideline has been developed by clinicians within the Renal Unit at RHC Glasgow.
The objective of this guideline is to aid in the diagnosis, investigation and management or acute renal failure in children. It includes the management of fluid and electrolyte abnormalities in children with acute renal failure.
This document is intended for use by clinicians in the Management and Investigation of Acute Renal Failure. For further information, contact a clinician within the Renal Unit. Ward office number 0141 452 4563
|Category||Estimated CCl (eCCL)||Urine Output|
|Risk||eCCl decrease by 25%||<0.5ml/kg/h for 8h|
|Injury||eCCl decrease by 50%||<0.5 ml/kg/h for 16h|
|Failure||eCCl decrease by 75% or eCCL <35 ml/min/1.73 m2||<0.3 ml/kg/h for 24h or anuric for 12h|
|Loss||Persistent failure >4 weeks|
|End stage||End-stage renal disease (persistent failure for >3 months)|
|Circulatory Insufficiency||Posterior Urethral Valves|
Impaired Cardiac Output
|"Renal Disease"||Neurogenic Bladder|
Renal Vessel occlusion
|Increased intraabdominal pressure||Latrogenic Factors||
*Avoid giving Ibuprofen
|- U&E’s, LFT’s and CRP||- LDH|
|- Uric acid||- FENa|
|- Magnesium||- Urinalysis|
|- Glucose||- Urinary Sodium, Osmolality|
|- Osmolality||- Microscopy for casts|
|- FBC ± Blood film||- Culture and sensitivity|
|- Coagulation Screen||- Renal Ultrasound|
|- Group and Save|
|- Parathyroid hormone (if acute on chronic suspected)||- Serum for toxicology/ drug levels|
|- C3||- Hepatitis Screen|
|- ASO titre, anti DNAse B||- E. Coli Antibody|
|- Antinuclear antibodies/ anti-DNA binding||- Stool culture|
|- Anti-GBM antibodies||- AXR|
|- ANCA (anti neutrophil cytoplasmic antibody)||- MCUG|
|- Blood culture||- Isotope scan|
|- XR left wrist and hand (signs of ROD in acute on chronic)|
|- Ophthalmology opinion|
|Urine Output||Oliguria||Oliguria - Polyuria||Variable|
|Lab studies||Increased Urea
by 45 –130 mmol/L/day
For calculation of FENa- http://www.mdcalc.com/fractional-excretion-of-sodium-fena/
Aim is to maintain isovolaemia erring on the side of minimal fluid overload.
As a rule of thumb, daily fluid requirements should equal insensible fluid losses plus output (urine, vomiting, drain losses, diarrhoea etc). Insensible fluid losses can be calculated as per the table below:
|Weight||Insensible Fluid Loss|
Hypernatraemia may be due to:
These are invariably acidosis and are often mixed respiratory and metabolic especially in the intensive care setting. Treatment is generally only indicated if there is associated hyperkalaemia or if the acidosis is profound.
Acute renal failure is a hypercatabolic state and requires aggressive nutritional support. Unlike adults there is no indication for dietary protein restriction, which should be delivered in amino acids or protein of high biological value. The majority of calories should however be delivered as carbohydrates.
May relate solely to salt and water overload and therefore in the presence of oligo/anuria and in the absence of hypovolaemia an initial trial of diuretic therapy is justified.
For further details of the management and investigation of hypertension – see appropriate protocol.
Drug therapy for the emergency treatment of hypertension is outlined below.
|Labetalol||1-5 mg/kg/hr||3-5 min||Alpha & beta Blocker||Hypoglycaemia
|Nifedipine||0.25-0.5 mg/kg||sublingual||5-10 min Ca channel blocker||
|Sodium Nitroprusside||0.5-8 ug/kg/min as IV infusion||Instant||Direct vasodilator||Thiocyanate poisoning|
|Clonidine||2-6 ug/kg||~10 min||Central alpha 2 Agonist||Depression
|Hydralazine||0.2 to 15mg/dose IV bolus
|5-10 min||Direct vasodilator||Headache,
1-3mg/kg over 15min
Last reviewed: 30 September 2017
Next review: 01 October 2020
Author(s): Ian Ramage
Approved By: Clinical Effectiveness