Renal Failure

What is renal failure?

Renal failure refers to temporary or permanent damage to the kidneys that results in loss of normal kidney function. There are two different types of renal failure: acute and chronic. Acute renal failure comes on quickly and may be reversible. Chronic renal failure progresses slowly over at least three months and can lead to permanent renal failure. The causes, symptoms, treatments, and outcomes of acute and chronic are different.

Acute renal failure can be caused by:

  • Decreased blood flow to the kidneys for a period of time. This may occur from blood loss, surgery, or shock.
  • An obstruction or blockage along the urinary tract.
  • Hemolytic uremic syndrome, which is usually caused by an E. coli infection. Kidney failure develops as a result of obstruction to the small functional structures and vessels inside the kidney.
  • Ingestion of certain medications that may be toxic to the kidneys.
  • Glomerulonephritis, which is a type of kidney disease that involves glomeruli. During glomerulonephritis, the glomeruli become inflamed and weaken the kidney’s ability to filter urine.
  • Any condition that may decrease or damage the steady flow of oxygen and blood to the kidneys, such as cardiac arrest.

Chronic renal failure can be caused by:

  • A prolonged urinary tract obstruction or blockage.
  • Alport syndrome, which is an inherited disorder that causes deafness, progressive kidney damage and eye defects.
  • Nephrotic syndrome, which is a condition characterized by protein in the urine, low protein in the blood, high cholesterol levels and tissue swelling.
  • Polycystic kidney disease, which is a genetic disorder characterized by the growth of numerous cysts filled with fluid in the kidneys.
  • Cystinosis, which is an inherited disorder in which the amino acid cystine (a common protein-building compound) builds up within specific cellular bodies of the kidney, known as lysosomes.

What are the symptoms?

The symptoms for acute and chronic renal failure may be different and each child may experience symptoms differently than another child with the same condition. Symptoms of renal failure also vary depending upon the underlying cause of the failure, especially in the case of acute renal failure.

Acute renal failure symptoms may include:

  • Hemorrhage
  • Fever
  • Rash
  • Bloody diarrhea
  • Severe vomiting
  • Abdominal pain
  • No urine output or high urine output
  • History of recent infection
  • Pale skin
  • History of taking certain medications
  • History of trauma
  • Swelling of the tissues
  • Inflammation of the eye
  • Detectable abdominal mass

Chronic renal failure symptoms may include:

  • Poor appetite
  • Vomiting
  • Bone pain
  • Headache
  • Stunted growth
  • High urine output or no urine output
  • Recurrent urinary tract infections
  • Urinary incontinence
  • Pale skin
  • Bad breath
  • Hearing deficit
  • Detectable abdominal mass
  • Tissue swelling
  • Irritability
  • Poor muscle tone
  • Change in mental alertness

The symptoms of acute and chronic renal failure may resemble other conditions or medical problems. The specialists at the CHOC Urology Center work with patients and their families to ensure an accurate diagnosis for each patient.

How is renal failure diagnosed?

In addition to a physical examination and complete medical history, our specialists may order the following tests. For more information on the tests used by our specialists, please read our guide to common diagnostic procedures.

  • Blood tests
    Blood tests will determine blood cell counts, electrolyte levels, and kidney function.
  • Urine tests
  • Renal ultrasound
    A noninvasive test that most parents are familiar with from pregnancy. A transducer (wand) is passed over the kidney producing sound waves that bounce off the kidney and send a picture of the inside of the body and kidney to a video screen. The test is used to determine the size and shape of the kidney, and to detect a mass, kidney stone, cyst or other obstruction or abnormalities.
  • Renal biopsy
    This procedure involves the removal of tissue samples (with a needle or during surgery) from the body for examination under a microscope.

What is the treatment?

Specific treatment will be determined by your child’s physician based on:

  • Child’s age, overall health and medical history
  • Extent of the disease
  • Disease type (acute or chronic)
  • Child’s tolerance for specific medications, procedures or therapies
  • Expectations for the course of the disease
  • Family’s opinion or preference

Specific treatment of acute renal failure depends on the underlying cause. Treatments may include:

  • Hospitalization
  • Administration of intravenous (IV) fluids in large volumes (to replace depleted blood volume)
  • Diuretic therapy or medications (to increase urine output)
  • Close monitoring of important electrolytes such as potassium, sodium and calcium
  • Medications (to control blood pressure)
  • Specific diet requirements

In some cases, children may develop toxic levels of certain waste products normally eliminated by the kidneys or fluid overload. Dialysis may be needed in these cases.

Treatment of chronic renal failure depends on the degree of kidney function that remains. Treatment may include:

  • Medications (to help with growth, prevent bone density loss, and/or to treat anemia)
  • Diuretic therapy or medications (to increase urine output)
  • Specific diet restrictions
  • Dialysis
  • Kidney transplantation

Most children with renal failure are followed by a pediatrician and a nephrologist (a physician who specializes in disorders or diseases of the kidneys).