Acute Renal Failure in the Neonate

Abstract

Although the exact prevalence of acute renal failure (ARF) in the neonate is difficult to determine precisely, patients who have mild-to-severe ARF are common in most neonatal intensive care units (NICUs). In most instances, the cause of failure is prerenal, in which cardiac output or renal blood flow are diminished, but intrinsic renal injury or postrenal obstructive processes also occur. By considering normal renal physiology, the mechanisms through which renal failure develops can be understood. This understanding is important in limiting the extent of injury and in developing therapies to control the effects of renal dysfunction on fluid and electrolyte balance, acidosis, and nutrition. Outcome and prognosis depend on comorbidities and the presence of failure in other organs as well as the cause and severity of ARF. Permanent effects may not be apparent until later in childhood, mandating careful follow-up and monitoring.