Advances in Paediatric Renal Replacement Therapy
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Most children who require acute renal replacement therapy (RRT) do not have primary renal diseases, but are managed in paediatric intensive care units (PICUs) for renal impairment that has occurred as a consequence of being critically ill. The primary driver of their acute renal failure (ARF) is usually kidney under-perfusion due to hypotension, which may be caused by intravascular hypovolaemia, or cardiac failure, or vasodilatation associated with sepsis, or combinations of these. Many authors prefer the term acute kidney injury (AKI) to ARF as it emphasises the fact that some children acquire long-term renal damage, but this is not logical because in many cases the kidney dysfunction results from reversible, protective physiological renal responses which do not result in any tissue injury, though acute proximal tubular necrosis (ATN) and more extensive cortical necrosis are frequently seen. The two commonest paediatric indications for RRT today are recent open-heart surgery associated with fluid overload, and multiple-organ dysfunction syndrome (MODS) [1–5]. Sometimes, RRT is used to augment normal kidney function to rapidly remove toxic metabolites, such as ammonia in babies born with rare genetic metabolic conditions .
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