Acute renal failure in falciparum malaria—a case report

A case of P. falciparum malaria with acute renal failure is reported. The urinary sodium of 42 mEg/L pointed towards a tubular pathology. There was no significant intravascular hemolysis as serum bilirubin was normal and plasma hemoglobin only mildly elevated. The pathogenesis of acute tubular necrosis due to heavy parasitemia is discussed. The other interesting feature which the patient exhibited was alternate day fever in the hospital and the peripheral smear showing only gametocytes repeatedly. Gametocytes do not give rise to symptoms. The patient responded well to quinine hydrochloride and the gametocytes disappeared. There is no satisfactory explanation for this phenomenon.     

Acute renal failure after exercise in a child with renal hypouricemia

We describe a 15 year old boy with renal hypouricemia who developed acute renal failure after a school athletics meeting, accompanied by appendicitis. During acute renal failure, the highest level of uric acid was 5.0 mg/dL, creatinine 7.9 mg/dL and urea nitrogen 58.6 mg/dL. After recovery, the serum uric acid fell to 0.9 mg/dL and the fractional excretion of uric acid (FEu_A) exceeded the normal range. The probenecid and pyrazinamide tests showed that the patient had a total defect of uric acid reabsorption. This case suggested that strenuous exercise could be responsible for acute renal failure in patients with renal hypouricemia.     

婴幼儿三聚氰胺相关泌尿系结石并发急性肾衰竭诊疗分析

目的 探讨食用受三聚氰胺污染的婴幼儿配方奶粉致泌尿系结石并发急性肾衰竭患儿的临床特点、诊断和治疗措施.方法 回顾性分析首都医科大学附属北京儿童医院和徐州市儿童医院2008年收治的34例因食用三聚氰胺污染的婴幼儿配方奶粉致泌尿系结石、梗阻发生急性肾衰竭的患儿.分析其流行病学、临床表现及影像学特点,总结4种不同的治疗方法 及疗效.结果 34名患儿均存在急性肾衰竭,血尿素氮(24.1±8.2)mmol/L,血肌酐(384.2±201.2)μmol/L.对留取的14例结石标本分析证实,结石是三聚氰胺和尿酸的合成体.膀胱镜治疗组血肌酐降至正常的平均时间为(3.5±1.9)d;切开取石组(2.7±1.1)d;透析组(3.8±2.3)d;内科保守治疗组(2.7±1.6)d.四组肾功能恢复时间差异无统计学意义(P=0.508),组问差异无统计学意义(P=0.803～1).经治疗34例患儿急性肾衰竭全部治愈,泌尿系结石完全或部分排出.肾功能恢复时间为(3.0±1.8)d.结论 三聚氰胺污染婴幼儿配方奶粉可以导致婴幼儿泌尿系结石引发的梗阻性急性肾衰竭,治疗首选药物或透析方法 纠正电解质紊乱,特别是高钾血症,尽快通过内、外科方法 解除梗阻引流尿液.患儿近期预后良好.     

小儿急性上尿路梗阻性肾衰的急诊处理

目的 探讨近期小儿急性上尿路结石梗阻致肾衰发病率升高的病因、临床特点、诊断及治疗.方法 我院近期收治40例急性上尿路梗阻致肾衰的病例,膀胱镜下行输尿管插管引流25例,腹膜透析8例,自行解除梗阻6例,肾盂造瘘1例.结果 所有40例急性肾功能衰竭患儿大部分有三鹿奶粉喂养史,主要表现为无尿,首选腹部B超检查;急性肾功能衰竭时及时解除结石梗阻,纠正酸碱失衡、水电解质紊乱.40例患儿上尿路梗阻完全解除,肾功能均恢复正常;结石成分主要为尿酸盐结石,结石多能自行排出.结论 三聚氰胺诱发尿酸盐结石可能是近期小儿梗阻性肾衰的主要原因.治疗手段包括膀胱镜输尿管插管、腹膜透析等.     

婴儿食用三聚氰胺污染奶粉致急性肾后性肾功能衰竭的治疗

目的 探讨因食用三聚氰胺污染奶粉致急性肾后性肾功能衰竭婴儿的外科急诊处理方法 与疗效.方法 应用半硬性输尿管镜(F6.8)逆行输尿管插管冲洗术11例,开放输尿管切开取石术2例.结果 本组除1例开放输尿管切开取石术后5h患儿又出现无尿且血红蛋白持续下降,再次行切口探查和腹膜透析外,其余12例均顺利恢复.本组13例肾功能均恢复正常,无手术并发症.结论 对婴儿因食用三聚氰胺污染奶粉致上尿路结石引起的急性肾后性肾功能衰竭,在输尿管镜下逆行捕管置入输尿管导管冲洗术是一种微创、安全而又有效的治疗方法 ;对婴儿尿道狭小输尿管镜不能进入者,开放输尿管切开取石术也是一种有效的方法 ,但对有明显出血倾向者需先纠正出血倾向后再考虑开放手术解除梗阻.     

Continuous renal prosthetic therapy in acute renal failure: an overview

The technology surrounding the treatment of acute renal failure has been traditionally left in the realm of dialysis. The use of peritoneal dialysis for the neonate or small infant and the often difficult use of hemodialysis in larger children and adolescents have been the mainstay of support. Not infrequently, however, the multisystem nature of the failure demonstrated by these patients made either form of therapy at best inadequate. The morbidity of the procedure would add to the already high morbidity of the disease and the patient would either be unable to receive the needed medications because of necessary fluid restrictions, or be subjected to severe hemodynamic or respiratory embarrassment due to the treatment methods themselves. It is precisely toward this patient population that the continuous forms of renal replacement therapy, reviewed herein, are directed.     

Neonatal ABO incompatibility. Complicated by hemoglobinuria and acute renal failure

The authors present two infants with isoimmune hemolytic disease due to ABO incompatibility complicated by massive hemoglobinuria and secondary acute renal failure. This represents an incidence of 0.36% of all neonates with ABO hemolytic disease in the author's newborn population. Only two patients have been reported previously to have similar complications. Analysis of data of these four infants revealed the clinical characteristics of this complication of ABO incompatibility: 1) very low frequency; 2) early onset of hemoglobinuria (first voided urine) and of acute renal failure (first 2 days of life); 3) lack of correlation between the clinical presentation of hemolytic disease and appearance and severity of renal failure; 4) complete recovery of renal functions following intravenous fluid administration; and 5) normal renal radiologic investigations.     

Renal failure in pediatric Castleman disease: Four French cases with thrombotic microangiopathy

Pediatric Castleman disease (CD) is an uncommon and poorly understood disorder of the lymph nodes. Renal failure has not been described in pediatric multicentric CD (MCD). We report four cases, who presented with polyadenopathy, organomegaly, edema and fluid accumulations, high blood pressure, and acute renal failure. In all cases, renal biopsy confirmed diffuse thrombotic microangiopathy. Definitive diagnosis of MCD was made by a biopsy of an affected lymph node located by computer tomography before initiation of corticosteroid therapy. Treatment of CD with corticosteroid therapy and rituximab was rapidly effective without relapse to date.     

Acute hepatic failure after open-heart surgery in children

Summary Acute hepatic failure (AHF) combined with acute renal failure (ARF) is a well-known complication of open-heart surgery in adults. The occurrence of this complication in two children after open-heart surgery for correction of congenital heart disease is reported. Hypotension occurred during the operation and was treated by catecholamine vasopressors. AHF set in during the postoperative course; it was manifested by impaired consciousness, hypoglycemia, hyperbilirubinemia, hyperammonemia, elevated liver enzymes and prolongation of the prothrombin time with failure of hemostasis. ARF also developed in both children. One of the patients survived the acute episode of hepatic failure. The importance of early diagnosis, routine close monitoring, and appropriate selection of vasopressors is emphasized.     

Acute renal failure in neonates

Acute renal failure (ARF) is a common condition seen in neonatal intensive care units. It is broadly classified into prerenal, intrinsic renal and post renal failure. There is no consensus on the definition of neonatal ARF. Of utmost importance is to differentiate prerenal from intrinsic renal failure. The most common causes of neonatal ARF are hypovolemia, hypotension and, hypoxia. Among several indices that are available for differentiating prerenal failure from intrinsic renal failure, fractional excretion of sodium is the preferred index. Diagnostic fluid challenge with or without frusemide is a bed side method for differentiating prerenal failure from intrinsic renal failure. Babies with ARF have to be monitored for several metabolic derangements like hyponatremia, hyperkalemia, hypocalcemia, and acidosis and have to be managed accordingly. Fluid balance should be precise in order to avoid fluid overload. It is difficult to provide adequate calories due to fluid restriction. Dialysis has to be instituted to preempt complications. Peritoneal dialysis is the easiest and safest modality. These babies need long term follow up as they are prone for long term complications.     

Exercise-induced acute renal failure in a girl with renai hypouricemia

A 10-year-old Japanese girl developed acute renal failure following a 100-meter dash during physical training at school. After the run, she experienced intense pain in the loins with nausea and vomiting lasting more than 12 h. On the following morning, she was found to have mild proteinuria and acute renal failure (ARF). Serum creatinine and blood urea nitrogen were elevated, but the serum uric acid level was normal (3.1 mg/dL). With recovery of renal function over the ensuing days, hypouricemia (0.6 mg/dL) became evident in the patient. Although the pathophysiological association between renal hypouricemia and ARF is not known, oxygen free radicals have been implicated in the pathogenesis for ischemic-reperfusion ARF. Superoxide production by neutrophils stimulated by N-formyl methionine leucyl-phenylalanine was normal in the patient both before and following exercise. Pyrazinamide and probenecid tests were undertaken on both the patient and her parents, who had borderline hypouricemia, to determine their renal tubular handling of uric acid. Results showed that the patient and her mother had a subtotal reabsorption defect, while the father had defective postsecretory uric acid reabsorption.     

The renal effects of radiocontrast administration during cardioangiography in two different groups with congenital heart disease

Renal effects of the administration of contrast media during cardiac catheterisation were compared in two groups of patients with congenital heart diseases. Group A consisted of 21 patients with cardiac malformations, characterised primarily by left ventricular valvular defects. Group B consisted of 23 patients with lesions affecting the right ventricle which are rarely associated with left heart failure, such as: Tetralogy of Fallot and Pulmonic stenosis.Patients in Group A showed a significant increment in both plasma creatinine and uric acid levels in the 24 h following heart catheterisation. This observation was significantly more prominent in the older age group (above the age of 5 years). In Group B no changes in these parameters were encountered. Plasma renin activity and fractional sodium excretion increased and decreased respectively, by a similar degree in both groups in the 24h following contrast media administration. No difference in renal tubular handling of uric acid was observed between both groups, nor did any of the patients studied demonstrate any degree of proteinuria or abnormality in the urine sediment, prior to or following heart catheterisation.We suggest that chronic pre-existing left ventricular overload should be considered a risk factor among the other known risk factors which promote the incidence of acute renal failure after contrast media administration. We also suggest that the reduction in glomerular filtration rate as evidenced in Group A by the increase in plasma creatinine and uric acid levels could be attributed to indirectly renin-mediated changes in systemic haemodynamics, probably induced by the high osmotically active contrast media. Patients with chronic pre-existing left ventricular volume overload are probably more prone to develop transient cardiac decompensation due to the transient hyper-osmolar state caused by the contrast media and which results in renal function impairment. Older children who have longstanding left ventricular overload are more prone to develop this transient cardiac decompensation, resulting in renal function impairment, than younger ones with the same cardiac lesions.Abbreviations GFR glomerular filtration rate - FeNa fractional sodium excretion - FeUa fractional uric acid excretion     

Acute infantile hemiplegia caused by cerebral ischemic infarction. Etiology, clinical features and investigations

In 19 children with acute infantile hemiplegia an ischemic cerebral infarct was found clinically and by serial computertomography. In 11 patients an angiography has been performed in addition. 9 of the children had chronic diseases which are known as predisposing factors for cerebrovascular disease (congenital heart disease in 7 and chronic renal failure with hypertension in 2). One child had a severe hypernatremic dehydration due to infantile diarrhea and in 1 child thrombosis of the internal carotid artery occurred 3 days after a perforating trauma of the soft palate. No obvious reason for the ischemic stroke could be evaluated in 8 children. The onset of symptoms was either acute or slowly progressive. An altered state of consciousness was present in 11 children. Hemiparesis was found in 18 patients (13 right, 5 left) accompanied by facial palsy in 12 and aphasia in 6. Seizures occurred in 6 patients. One patient with incomplete occlusion of a vertebral artery showed acute cerebellar ataxia. In children without predisposing factors the prevalence of girls was higher (2 : 6) and there was a history of a preceding acute febrile illness in 5 of 8 patients. Laboratory investigations showed polycythemia in 4 children with cyanotic heart disease and additional hypochromia in two. Blood sedimentation rate was increased in 6 out of 8 patients without a known predisposing factor. Cerebrospinal fluid (CSF) showed a slight increase of erythrocytes (36-88/cmm) in 4 children, in two others purulent CSF was obtained after the infarct had developed into a brain abscess. The etiology of ischemic stroke in childhood and the possibility of an inflammatory vascular disease are discussed.     

Liver transplantation for acute liver failure due to toxic agent ingestion in children

Abstract: ALF is characterized by sudden onset, impaired liver function, jaundice and encephalopathy, without previous liver disease. We analyzed the patients who underwent LT due to toxic agent induced ALF to raise community awareness about preventing the toxic agent induced ALF. Five children (three boys, two girls) underwent LT due to toxic agent ingestion. Toxic agents were mushroom poisoning (n = 2), Datura stramonium (n = 1), yellow phosphorous (n = 1) and INH (n = 1). On admission, one patient had stage IV, two had stage III and two had stage II hepatic encephalopathy but worsened during the follow‐up. One patient had renal failure, and three patients required mechanical ventilation. Three patients underwent LRLT and others from a DD. Post‐operative complications were managed by supportive managements successfully, and overall all the patients are alive (100% survival) without any organ sequelae. Although outcome of these patients are excellent, ALF may be prevented in these cases by educating the public about consuming mushrooms and toxic effects of wild plants, prohibiting fireworks and serial liver enzyme measurements after initiating INH.     

Acute pyelonephritis with renal abscesses and acute renal failure after salmonella infection

Urinary tract infections, renal abscess formation and acute renal failure (ARF) after salmonella infection are rarely reported in children. We present a previously healthy teenager who developed ARF with renal abscess formation after salmonella infection, in whom we believe that acute salmonella pyelonephritis was the main causative factor for ARF and not dehydration, shock or rhabdomyolysis, which have already been described in the literature. With prolonged antibiotic treatment and adequate hydration, the boy’s condition improved, but chronic kidney disease was unfortunately inevitable. Conclusion: Salmonella pyelonephritis has, according to our knowledge, not yet been described to be the main causative factor of ARF in previously healthy children, as was the case in our patient. Long‐term antibiotic treatment of at least 6 weeks is probably a must in such patients, even though chronic kidney disease could not have been prevented.     

Acute renal failure following wasp sting in children

The medical records of patients admitted between 1985 and 2007 with wasp stings were retrospectively analyzed. Among the 45 children, seven developed acute renal failure. Classical clinical and laboratory data pointed to hemolysis and rhabdomyolysis as the underlying pathophysiology. All patients had hyponatremia and hyperkalemia as well as metabolic acidosis. Six patients had anemia. Five patients were oliguric for 9 to 15 days. Maximum serum creatinine was 4.0 to 11.9 mg/dl. Peritoneal dialysis was performed for 3 to 15 days. One patient died due to hyperkalemia, the remaining ones recovered completely. This paper wants to remind pediatricians to watch for acute renal failure in children with wasp stings.     

Ascitic fluid drainage using a peritoneal dialysis catheter to prevent and treat multi‐organ dysfunction in veno‐occlusive disease in children undergoing hematopoietic stem cell transplantation

Veno‐occlusive disease (VOD), or sinusoidal obstruction syndrome, is a well‐recognised, serious complication associated with the chemotherapy conditioning therapy used in hematopoietic stem cell transplantation (HSCT). Fluid management is typically challenging in children with this condition. We describe effective early use of peritoneal dialysis catheters to drain extravascular, intra‐abdominal fluid in children with VOD, allowing intravascular fluid administration to preserve renal perfusion and function, preventing multi‐organ dysfunction. All but one of the children are long‐term survivors, both of their significant VOD and their HSCT. The child that did not survive died from their underlying metabolic illness, not VOD.     

Febrile convulsion during the acute phase of Kawasaki disease

BACKGROUND: Although seizures occur in association with meningitis or encephalitis in Kawasaki disease, febrile convulsions in Kawasaki disease are considered to be extremely rare. The aim of the present study is to elucidate the incidence of febrile convulsion in the acute phase of Kawasaki disease, in Niigata City General Hospital, Niigata, Japan. METHODS: The study included 177 patients with Kawasaki disease. Patients ranged in age from 2 months to 10 years (mean age 26.89 +/- 22.44 months). The study included 105 males and 72 females. The clinical records of Kawasaki disease patients were examined retrospectively. RESULTS: Febrile convulsions were not recognized in these 177 patients throughout the course of the disease, despite the presence of a high grade fever and their young age. However, eight of the 177 patients had experienced simple febrile convulsions during other febrile illness except for those with Kawasaki disease. In the acute phase of Kawasaki disease, only two patients showed generalized convulsion associated with prolonged consciousness disturbance and pleocytosis in the cerebrospinal fluid. CONCLUSION: The incidence of febrile convulsions in the acute phase of Kawasaki disease might be extremely low, confirming the results of previous reports. Kawasaki disease is characterized by systemic vasculitis and is sometimes complicated by intracranial vasculitis. The incidence of electroencephalographic abnormalities and pleocytosis in the cerebrospinal fluid is higher in patients with Kawasaki disease. However, the reason why febrile convulsions did not occur in the acute phase of Kawasaki disease remains unknown, despite the presence of central nervous system involvement.     

Doppler evaluation of renal blood flow velocity as a predictive index of acute renal failure in perinatal asphyxia

Aim of our study was to evaluate Doppler renal blood flow velocity in asphyxiated neonates and to correlate renal function to Doppler findings. Doppler renal blood flow velocity was evaluated in 23 severely asphyxiated neonates born at a gestational age >32 weeks and compared to our standard Doppler data obtained in 25 healthy neonates comparable for gestational age and birth weight. Renal Doppler ultrasound was performed on the 1st and 3rd days of life. Renal function was investigated in the first 2 weeks of life. Asphyxiated neonates showed mean values of systolic velocity and mean velocity significantly reduced (P< 0.001) compared with our standard Doppler values on the 1st day of life. Seven out of the 23 asphyxiated neonates were affected by acute renal failure and 14 showed no renal involvement. Two neonates were oliguric but did not develop acute renal failure. On the 1st day of life, neonates with acute renal failure had significantly lower mean values of systolic velocity and mean velocity than the asphyxiated neonates without renal involvement (P< 0.01). All 7 neonates affected by acute renal failure showed a systolic velocity more than 2SD below the mean standard value, while only 4 of the 16 asphyxiated neonates (25%) without acute renal failure had low systolic velocity values on the 1st day of life. Doppler velocities in asphyxiated neonates were similar to standard values on the 3rd day of life. Renal failure recovered before the 11th day of life in all cases. Conclusion Our findings indicate that decreased Doppler renal flow systolic velocity observed in asphyxiated neonates on the 1st day of life is a useful predictive index for subsequent development of acute renal failure, with 100% sensitivity and 63.6% specificity. Received: 21 July 1997 / Accepted in revised form: 24 November 1997     

Acute reversible kidney failure in IgA nephritis

Four patients with acute renal failure during an acute course of IGA-nephritis are described. Percutaneous renal biopsies showed only minor glomerular lesions in all patients. Immunosuppressive therapy was not necessary. In all patients acute renal failure was completely reversible. The four patient showed further episodes of macrohematuria without acute renal failure. All patients had normal renal function, normotensive blood pressure and microhematuria during interval. In three of the patients we found erythrocytes casts and a mild protein excretion. IGA-nephritis is one of the most common types of glomerulonephritis in adolescents and adults. If acute renal failure occurs during a course of IGA-nephritis with macroscopic haematuria a percutaneous renal biopsy has to be performed. Only in case of severe crescents formation (greater than 75%) immunosuppressive therapy is necessary. Glomerular lesions are responsible for long time prognosis.