Management of acute renal failure in newborns

Acute renal failure (ARF) is a frequent clinical condition in neonatal inte nsive care units. Plasma creatinine concentrations should be used with some caution for ARF diagnosis in the first days of life. An intravenous fluid challenge allows differentiation of prerenal failure and intrinsic renal fa ilure. All clinical conditions associated with hypovolemia, hypoxemia, and hypotension in the newborn infant may lead to renal insufficiency, the lead ing causes being perinatal anoxia-ischemia and sepsis. The initial treatmen t mainly relies on correction of hypotension, acidosis, and hypoxemia, in o rder to reduce renal vasoconstriction and improve renal perfusion. If neces sary, the main renal replacement therapy is usually peritoneal dialysis eve n if skilled medical and nursing personnel are available in some neonatal i ntensive care units to perform hemofiltration and hemodiafiltration safely.