Neonatology pp 1027-1039 | Cite as

Acute and Chronic Renal Failure in the Newborn Infant

  • Jean-Pierre Guignard
  • Uma S. Ali


Acute renal failure (ARF) is the consequence of a sudden decrease in glomerular filtration rate with consequent retention of nitrogen waste products and disturbances in water, electrolyte and acid-base balance. Because of its physiological specifics, the premature fetal and neonatal kidneys are particularly vulnerable to common endogenous and exogenous stresses occuring before birth, during delivery or after birth. Clinical studies have shown that 8–24% of all neonates hospitalized in intensive neonatal care units may present with ARF [1–4]. The causes of ARF (Table 125.1) are divided into prerenal (functional), renal (intrinsic) and postrenal (obstructive) causes. Functional pre-renal insufficiency is the most frequent form of ARF. It is preventable if treated early and adequately.


Glomerular Filtration Rate Acute Renal Failure Chronic Renal Failure Renal Replacement Therapy Posterior Urethral Valve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Gouyon JB, Guignard JP (2000) Management of acute renal failure in the newborn. Pediatr Nephrol 14: 1037–1044PubMedCrossRefGoogle Scholar
  2. 2.
    Toth-Heyn P, Drukker A, Guignard JP (2000) The stressed neonatal kidney: from pathophysiology to clinical management of neonatal vasomotor nephropathy. Pediatr Nephrol 14: 227–239PubMedCrossRefGoogle Scholar
  3. 3.
    Andreoli SP (2004) Acute renal failure in the newborn. Semin Nephrol 28: 112–123Google Scholar
  4. 4.
    Andreoli SP (2008) Renal failure in the neonate. In: Oh W, Guignard JP, Baumgart S (eds) Nephrology and fluid/electrolyte physiology: Neonatology questions and controversies. Saunders Elsevier, Philadelphia, pp 208–224Google Scholar
  5. 5.
    Guignard JP, John G (1986) Renal function in tiny premature infant. Clin Perinatol 13: 377–401PubMedGoogle Scholar
  6. 6.
    Drukker A, Guignard JP (2002) Renal aspects of the term and preterm infant: a selective update. Curr Opin Pediatr 14: 175–182PubMedCrossRefGoogle Scholar
  7. 7.
    Rodriguez MM, Gomez A, Abitbol C, Chandar J (2004) Comparative renal histomorphometry: a case study of oligonephropathy of prematurity. Pediatr Nephrol 20: 945–949CrossRefGoogle Scholar
  8. 8.
    Guignard JP, Drukker A (1999) Why do newborn infants have a high plasma creatinine? Pediatrics 103: e49Google Scholar
  9. 9.
    Choker G, Gouyon JB (2004) Diagnosis of acute renal failure in very preterm infants. Biol Neonate 86: 212–216PubMedCrossRefGoogle Scholar
  10. 10.
    Chevalier RL (2008) Obstructive uropathy: assessment of renal function in the fetus. In: Oh W, Guignard JP, Baumgart S (eds) Nephrology and fluid/electrolyte physiology: Neonatology questions and controversies. Saunders Elsevier, Philadelphia, pp 225–250Google Scholar
  11. 11.
    Guignard JP, Gouyon JB (1988) Adverse effects of drugs on the immature kidney. Biol Neonate 53: 243–252PubMedCrossRefGoogle Scholar
  12. 12.
    Allegaert K, Vanbole C, DeHoon J et al (2005) Non-selective cyclooxygenase inhibitors and glomerular filtration rate in preterm neonates. Pediatr Nephrol 20: 1557–1561PubMedCrossRefGoogle Scholar
  13. 13.
    Kaplan BS, Restaino J, Raval DS et al (1994) Renal failure in the neonate associated with in utero exposure to non-steroidal anti inflammatory agents. Pediatr Nephrol 8: 700–704PubMedCrossRefGoogle Scholar
  14. 14.
    Ali U, Khubchandani S, Andankar P et al (2006) Renal tubular dysgenesis associated with in utero exposure to nimuselide. Pediatr Nephrol 26: 274–276CrossRefGoogle Scholar
  15. 15.
    Mason B (1994) Teratogen update. Angiotensin converting enzyme inhibitors. Teratology 50: 399–409CrossRefGoogle Scholar
  16. 16.
    Gouyon JB, Guignard JP (1988) Theophylline prevents the hypoxemia induced renal hemodynamic changes in rabbits. Kidney Int 33: 1078–1083PubMedCrossRefGoogle Scholar
  17. 17.
    Thijs A, Thijs LG (1998) Pathogenesis of renal failure in sepsis. Kidney Int 53 (Suppl 66) 534–537Google Scholar
  18. 18.
    Camussi G, Ronco C, Montrucchio G, Picolli G (1998) Role of soluble mediators in sepsis and renal failure. Kidney Int 3: S38–S42Google Scholar
  19. 19.
    Hunley TE, Kon V (2001) Updates on endothelins-biology and clinical implications. Pediatr Nephrol 16: 752–762PubMedCrossRefGoogle Scholar
  20. 20.
    Kruper JN, Groenweld AB, Slutsky AS, Plotz FB (2005). Mechanical ventilation and acute renal failure. Crit Care Med 33: 1408–1415CrossRefGoogle Scholar
  21. 21.
    Sanna-Cherchi S, Ravani P, Corbani V et al (2009) Renal outcome in patients with congenital anomalies of the kidney and urinary tract. Kidney Int 76: 528–33PubMedCrossRefGoogle Scholar
  22. 22.
    Ong WH, Guignard JP, Sharma A, Aranda JV (1998) Pharmacological approach to the management of neonatal hypertension. Semin Neonatol 3: 149–163CrossRefGoogle Scholar
  23. 23.
    Karlowicz MG, Adelman RD (1995) Non-oliguric and oliguric acute renal failure in asphyxiated newborns. Pediatr Nephrol 9: 718–722PubMedCrossRefGoogle Scholar
  24. 24.
    Gallini F, Maggio L, Romagnoli C et al (2000) Progression of renal function in preterm neonates with gestational aged < 32 weeks. Pediatr Nephrol 15:119–124PubMedCrossRefGoogle Scholar
  25. 25.
    Miall LS, Henderson MJ, Turner AJ et al (1999) Plasma creatinine rises dramatically in the first 48 hours of life in preterm infants. Pediatrics 104: e76Google Scholar
  26. 26.
    Guignard JP (2008) Glomerular filtration rate in neonates. In: Oh W, Guignard JP, Baumgart S (eds) Nephrology and fluid/electrolyte physiology: Neonatology questions and controversies. Saunders Elsevier, Philadelphia, pp 79–96Google Scholar
  27. 27.
    Daschner M (2005) Drug dosage in children with reduced renal function. Pediatr Nephrol 20: 1675–1686PubMedCrossRefGoogle Scholar
  28. 28.
    Seri I (2006) Hydrocortisone is effective in treatment of vasopressin- resistant hypotension in very low birth weight neonates. J Pediatr 149: 422–423PubMedGoogle Scholar
  29. 29.
    Seri I (1995) Cardiovascular, renal and endocrine actions of dopamine in neonates and children. J Pediatr 121: 771–775Google Scholar
  30. 30.
    Australian and New Zealand Intensive Care Society Clinical Trials Group (2000) Low dose dopamine in patients with early renal dysfunction: a placebo controlled trial. Lancet 356: 2139–2143CrossRefGoogle Scholar
  31. 31.
    Dubourg L, Drukker A, Guignard JP (2000) Failure of the loop diuretic torasemide to improve renal function of hypoxemic vasomotor nephropathy in the newborn rabbit. Pediatr Res 47: 504–508PubMedCrossRefGoogle Scholar
  32. 32.
    Rees L (2008) Management of the neonate with chronic renal failure. Semin Fetal Neonatal Med 13: 181–188PubMedCrossRefGoogle Scholar
  33. 33.
    Ohlsson A, Hosking M (1987) Complications following oral administration of exchange resins in extremely low birth weight infants. Eur J Pediatr 146: 571–574PubMedCrossRefGoogle Scholar
  34. 34.
    Warady BA, BunchmanT (2000) Dialysis therapy for children with acute renal failure: survey results. Pediatr Nephrol 15: 11–13Google Scholar
  35. 35.
    Otukesh H, Hoseini R, Hooman N et al (2006) Prognosis of acute renal failure in children. Pediatr Nephrol 21: 1873–1878PubMedCrossRefGoogle Scholar
  36. 36.
    Abitbol CL, Bauer CR, Montane B et al (2003) Long term followup of ELBW infants with neonatal renal faiure. Pediatr Nephrol 18: 887–895PubMedCrossRefGoogle Scholar
  37. 37.
    Jenik AG, Cernadas JMC, Gorenstein A et al (2000) A randomized, double blind, placebo controlled trial of the effects of prophylactic theophylline on renal function in term neonates with perinatal asphyxia. Pediatrics 105: E45PubMedCrossRefGoogle Scholar
  38. 38.
    Bhat MA, Shah ZA, Makhdoomi MS, Mufti MH (2006) Theophylline for renal function in term neonates with perinatal asphyxia: a randomized placebo controlled trial. J Pediatr 149: 180–184PubMedCrossRefGoogle Scholar
  39. 39.
    Catarrelli D, Spandrio M, Gasparoni A et al (2006) A randomized double blind placebo trial of the effect of theophylline in prevention of vasomotor nephropathy in very preterm neonates with respiratory distress syndrome. Arch Dis Child fetal and neonatal edition 91: F80–F84CrossRefGoogle Scholar
  40. 40.
    Wedekin M, Ehrich JHH, Offner G, Pape L (2008) Aetiology and outcome of acute and chronic renal failure in infants. Nephrol Dial Transplant 23: 1575–1580PubMedCrossRefGoogle Scholar
  41. 41.
    Kousidis G, Thomas DF, Morgan H et al (2008) The long-term outcome of prenatally detected posterior urethral valves: a 10 to 23- year follow-up study. BJU Int 102: 1020–1024PubMedCrossRefGoogle Scholar
  42. 42.
    Pinto E, Guignard JP (1995) Renal masses in the neonate. Biol Neonate 68: 174–184Google Scholar
  43. 43.
    Hanna JD, Krieg RJ Jr, Scheinman JI, Chan JC (1996) Effects of uremia on growth in children. Semin Nephrol 16: 230–241PubMedGoogle Scholar
  44. 44.
    Haffner D, Fischer DC (2009) Growth hormone treatment of infants with chronic kidney disease: requirement, efficacy, and safety. Pediatr Nephrol 24: 1097–1100PubMedCrossRefGoogle Scholar
  45. 45.
    Cano FJ, Azocar MA, Guerrero JL et al (2007) Intraperitoneal calcitriol in infants on peritoneal dialysis. Perit Dial Int 27: 651–653Google Scholar
  46. 46.
    Hijazi R, Abitbol CL, Chandar J et al (2009) Twenty-five years of infant dialysis: a single center experience. J Pediatr 155: 111–117PubMedCrossRefGoogle Scholar
  47. 47.
    Rheault MN, Rajpal J, Chavers B, Nevins TE (2009) Outcomes of infants < 28 days old treated with peritoneal dialysis for end-stage renal disease. Pediatr Nephrol 24:2035–2039PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Jean-Pierre Guignard
    • 1
  • Uma S. Ali
  1. 1.University of Lausanne Medical SchoolCentre Hospitalier Universitaire Vaudois (CHUV)LausanneSwitzerland

Personalised recommendations