General clinical manifestations

 If a child presents with a three day hx of

vomiting and diarrhea-prerenal ARF
 Six years old child with a recent pharyngitis
presents with periorbital edema, HTN, and gross
hematuria- Intrinsic ARF
 A critically ill child with a hx of protracted
hypotension and exposure to nephrotoxic
medications- ATN
 Congenital urinary tract obstruction probably
related to partial urethral valves- post renal ARF
 Physical Examinations
 Prerenal
Tachycardia
Dry mucosal membrane
Poor peripheral perfusion suggest inadequate
circulatory volume
 Intrinsic renal
Peripheral edema
Rales/ crepitations
Cardiac gallop suggest volume overload
 Post renal
Palpable flank mass
Loin pain
Flank fullness
Suprapubic distension suggest urinary tract
obstruction at different anatomical sites
 Hemolytic Uremic Syndrome
 Most common in children < 4yrs
 Usually preceded by gastroenteritis and upper
respiratory tract infection
 Fever, vomiting, abdominal pain
 Sudden onset of pallor, irritability, weakness,
lethargy, oliguria usually occur 5-10 days after
infection
 Physical Examination
 Dehydration
 Edema
 Petechiae
 Hepatosplenomegaly
 Marked irritability
 Acute glomerulonephritis
 Clinical features
Usually follows pharyngitis and skin infections
Specific symptoms are malaise. Lethargy,
abdominal and flank pain and fever
Patient may develop edema, HTN and oliguria
 Complications
 Fluid overload ( HTN, pulmonary edema,
CHF)
 Electrolyte disturbance ( Hyperkalemia,
hypocalcaemia, hyperphosphatemia)
 Metabolic acidosis
 uremia
 Investigations
CBC, HG OR HCT,
WBC with differentials
PLATELET
Reticulocyte count
RBC morphology
URINALYSIS {hematuria, proteinuria, RBC
& granular casts, WBC casts, pyuria}
 Renal function tests
BUN & CR
URIC ACID
K⁺, Ca⁺⁺, PO₃⁻
ANTIGENS
Streptococcal, nuclear, neutrophil
cytoplasmic, glomerular basement
membrane
 Major Serum Electrolytes
PH value
CULTURE
BLOOD, THROAT, STOOL,
URINE
CHEST X RAY
RENAL U/S
PRE RENAL ARF INTRINSIC ARF

Sp gravity >1.020 Sp gravity <1.010

Urine Osmolality >500mosm/Kg Urine Osmolality <350mosm/Kg

Low urine Na <20 mEq/L High urine Na >40 mEq/L

FENa <1% ( <2.5% in neonates) FENa >2% ( >10% in neonates)

Ratio of urine to plasma CR >14:1 Ratio of urine to plasma CR <14:1

 Monitoring Therapy
 Vital signs
 Input and output
 Physical examination
 Electrolytes
 Principles of Management
 Correct hypoperfusion to prevent renal cell
injury
 Isotonic fluid( NS or LR- 20ml/kg for 20 min.)
 Blood or IV albumin -1gm/kg
 In metabolic acidosis no LR
 Fluid balance along with indwelling catheter
 Correct cardiac failure with inotropes
 Mannitol (0.5gm/kg) and diuretics ( 1-
5mg/kg)
 Calories supplement with 400cal/ml after first
2-3 days
 Treat HTN (fluid and salt restriction and
antihypertensive)
 Restrict K⁺ intake and if there is hyperkalemia
we can use 7.5% NaHCO₃, 2-3mEq/kg over 30-
60 min.or glucose o.5gm/kg with 0.3units of
insulin/gm of glucose.
 Dialysis ( fluid overload, hyperkalemia,
metabolic acidosis, uremia)
Thank you