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Article
Acute renal failure in children under two years of age

Author: Nariman Fahmi Ahmed
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 / 24108057 Year: 2008 Volume: 50 Issue: 2 Pages: 139-144
Publisher: Baghdad University جامعة بغداد

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Abstract

Summary:
Background: Acute renal failure (ARF) in children is a catastrophic, life -threatening
event
Aim of the study: the aim of the present study is to find out the etiology and outcome
of patients with acute renal failure below two years of age admitted to the hospital.
Patients and methods: A prospective study was carried out on children below 2
years of age (with exclusion of neonatal period) presented with acute renal shut down
admitted to Children Welfare Teaching Hospital during the period from Jan. 1st
,
2007tojan30th
,2008.
Results: the study group included 100 patients with acute renal failure, 69 males and
31 females with M/F ratio 2.2:1.Age range was between (2 months - 2 years).
Prerenal ARF was the commonest type seen in 67(67%) patients and hypovolemia
due to (gastrointestinal loss) was the prominent etiology it was found in 53(53%)
cases. ARF due to renal and post-renal causes found in 21(21%) and 12(12%) cases
respectively, six (6%) patients only presented with non-Oligouria.
Forty four patients (44%) required peritoneal dialysis, while(56)patients improved on
conservative management only and most of them (53 %) were the pre-renal group.
Ninety two (92%) patients had either complete or partial recovery of their renal
function, eight (8%) patients died from ARF.
Conclusion: prerenal ARF particularly hypovolemia secondary to gastrointestinal
loss was the most common causative group of ARF in our patients, with good
prognosis for the recovery of renal function in most patients. To evaluate and validate
markers of acute kidney injury more prospective clinical studies required.


Article
8- Educational Article POSTOPERATIVE ACUTE RENAL FAILURE, THE ROLE OF ANESTHESIOLOGISTS…51

Authors: JASIM M SALMAN --- SALAM N ASFAR
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2009 Volume: 15 Issue: 1 Pages: 51-52
Publisher: Basrah University جامعة البصرة

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Abstract


Article
Acute Renal Failure in Children Below 12 Years Causes, Clinical Presentation and Management

Author: Bushra Jalil Salih
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 1 Pages: 33-39
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Acute renal failure (ARF) is a common condition in hospitalized patients, characterized by a rapid fall in glomerular filtration rate (GFR), carries a high morbidity and mortality, often preventable, so rapid recognition and treatment may prevent irreversible loss of nephrons.OBJECTIVE:To find out the cause of acute renal failure in children and to study the clinical presentation and management modalities and sequel.METHODS:A prospective study done in Central Teaching Hospital for children from January 2006 to December 2006. 120 patients aged 1month- to 12 years who were diagnosed and treated as cases of acute renal failure were collected & analyzed. And the distribution of patients according to (age, sex, type of presentation, laboratory finding, type of management and sequel) were done.RESULTS:From hundred twenty patients, there were 77 male and 43 female with 1.7:1 ratio distributed into 93 infant, 14 preschool and 13 school age group .The main type of presentation was acidosis ,oliguria & dehydration. The main causes were gastroenteritis, sepsis and obstructed uropathy in infancy and preschool children, glomerular disease in school age group. 97 need conservative treatments and 23 need urgent peritoneal dialysis (PD) with mortality rate 5.15%, 30.51% respectively.CONCLUSION:Acute renal failure occurred more in infancy and most of them were prerenal acute renal failure can be handled with conservative treatment; peritoneal dialysis is a good choice for treatment of acute renal failure not resolved by conservative therapy.


Article
Acute Renal Failure in Neonates

Authors: Nariman Fahmi Ahmed Azat --- Afrah abdalmahdi Salih --- Manal Bahnam Naoom
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 2 Pages: 145-148
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Acute renal failure (ARF) is a common problem in admitted neonates in intensive care units. In most patients ARF accompanies with a predisposing factor such as sepsis, heart failure, perinatal asphyxia or prematurity.OBJECTIVE:This study was to determine the causes and outcome of ARF in hospitalized newbornPATIENTS AND METHODS:In a descriptive cross sectional study we evaluated neonates with ARF who had been hospitalized in Children welfare teaching Hospital from july 2009 to july2010.RESULTS:There were 50 cases diagnosed as ARF in 2500 hospitalized neonates (2%).The male to female ratio in patients with ARF was 3.16:1.Most of involved patients were term 35(70%).The prevalence of renal, pre renal and post renal causes of ARF was 29 (58%), 15(30%) and 6(12%) respectively.The most common predisposing factors for ARF in our study was sepsis 28(56%), genitorenal anomalies 15(30%), perinatal asphyxia 3(6%), drug toxicity in 3(6%)One patient (2%) had respiratory distress syndrome. Among admitted neonates with ARF 6(12%) died and it was significantly higher in patients with sepsis (P<0.05). CONCLUSION: ARF is a common emergency entity , physicians play a critical role in recognizing early ARF, preventing iatrogenic injury, and reversing the course of ARF.


Article
The nephroprotective effect of some vasodilators and vitamins in experimental model of acute renal failure

Authors: dr. Faruk H. Aljawad د. فاروق الجواد --- Rana Muhsin Khalaf رنا محسن خلف
Journal: Thi-Qar Medical Journal مجلة ذي قار الطبية ISSN: 19929218 Year: 2007 Volume: 1 Issue: 1 Pages: 65-74
Publisher: Thi-Qar University جامعة ذي قار

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Abstract

AbstractBackground: Myoglobinuric ARF is an example of intrinsic type of renal failure induced by intramuscular injection of glycerol. Materials and methods: this study has been conducted using 36 local domestic rabbits. They were separated in to 6 groups, each one has been pre-treated with a test agent (vitamin C and E, amlodipine, carvedilol and verapamil) 2 hours prior to administration of glycerol. The changes in renal function have been followed up by monitoring the levels of BUN, serum creatinine, K¬+and Na+ after 3 and 7 days of the induction.Results: pretreatment with vitamin C, vitamin E, carvedilol and verapamil cause significant reduction in the levels of BUN, serum creatinine and K¬+ and significant elevation of serum Na+when compared with the control group. While pretreatment with amlodipine causes significant elevation of BUN, serum creatinine and K¬+. Conclusion: Vitamin C, E, carvedilol and verapamil have a significant nephroprotective effect at the tested doses in this model of acute renal failure with a possible use in prevention of acute renal failure.

ملخص البحث:تمهيد: العجز الكلوي الحاد هو متلازمة تتميز بالانخفاض الحاد في معدل الترشيح الكبيبي, تراكم نواتج الايض النيتروجينية مع اضطراب في حجم السائل خارج الخلوي و اختلال التوازن الأيوني وتوازن الحامض و القاعدة في الجسم.في هذه الدراسة تم استخدام العجز الكلوي الحاد الناجم عن الميوغلوبين كنموذج تجريبي, وهو احد أنواع الجز الداخلي المنشأ. اذ ينتج عن تلف العضلات الهيكلية و تحرر محتويات الخلية العضلية خاصة الميوغلوبين إلى الدورة الدموية مسببا تدهورا سريعا في وظيفة الكلية.الهدف: الهدف من الدراسة هو استكشاف التأثير الواقي للكلية المحتمل لبعض الأدوية الموسعة للأوعية الدموية (كارفيدايلول, املودبين و فيراباميل) و بعض الفيتامينات المضادة للتأكسد (فيتامين سي و أي).الطرق: تم استخدام ست و ثلاثون أرنب محلي حيث قسمت إلى ست مجاميع و كانت إحداها مجموعة سيطرة. لقد حقنت الحيوانات فيها بمادة الغليسيرول بتركيز 50% عضليا و بجرعة 9 مليلتر لكل كيلوغرام من وزن الجسم لغرض إحداث العجز الكلوي, أما بقية المجاميع فقد تمت معالجة كل مجموعة باحدى المواد المراد فحصها أعلاه وقبل إعطاء الغليسيرول بساعتين. قيمت وظيفة الكلية من خلال قياس مستوى اليوريانيتروجين في الدم و مستوى كل من الكرياتنين و البوتاسيوم و الصوديوم في مصل الدم لمرتين, إحداهما بعد مرور ثلاثة أيام على إحداث العجز الكلوي و الأخرى بعد مرور سبعة أيام, ثم قورنت النتائج بالقيم السوية و بنتائج مجموعة السيطرة لتقييم تأثير المواد المختبرة الواقي للكلية.النتائج: بينت الدراسة أن المعالجة اليومية بجرعة واحدة من فيتامين سي ( 250 ملغم/كغم/اليوم) أو فيتامين إي ( 200 ملغم/كغم/اليوم) تعطى فمويا للحيوانات مع تكرارها لثلاثة أيام متعاقبة بعد إحداث العجز الكلوي أدت إلى انخفاض معتد لمستويات كل من اليوريانيتروجين و الكرياتنين و البوتاسيوم وارتفاع لمستوى الصوديوم في المصل عند مقارنته مع مجموعة السيطرة مع بقاء مستوى الصوديوم قريبا من المستوى الطبيعي.ان المعالجة بكل من كارفيدايلول ( 6.25ملغم/كغم) و فيراباميل ( 2,5ملغم/كغم) كجرعة واحدة تعطى فمويا قبل إحداث العجز الكلوي سبب نقصا معتدا لمستويات كل من اليوريانيتروجين و الكرياتنين و البوتاسيوم وارتفاع لمستوى الصوديوم في المصل عند مقارنته مع مجموعة السيطرة, في حين أن استخدام املودبين( 1,25ملغم/كغم) قبل إحداث العجز الكلوي لم يسبب تغيرا معتدا.الاستنتاجات: من النتائج المتقدمة تبين أن هناك تأثيرا واقيا لكل من فيتامين سي و أي, كارفيدايلول و فيراباميل في الجرع المستخدمة في هذا النوع التجريبي من العجز الكلوي الحاد مما قد يعطي فرصا علاجية أو وقائية للمرضى المعرضين للإصابة بالعجز الكلوي الحاد.


Article
Peritoneal Dialysis in Children with Acute Renal Failure in Ibn Al-Balady Hospital

Author: Salim Zyarah Abdullah
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 1 Pages: 1-6
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND : Acute renal failure (ARF) is most important condition in pediatric nephrology units with variable causes vary from place to place and peritoneal dialysis(PD) is the easy and feasible modality of treatment for acute renal failure in small and young children and hemodynamically unstable patients were other modalities not suitable for them.OBJECTIVE:To stady the aetiology and prognosis of the patients with acute renal that required peritoneal dialysis in ibn al balady hospital.METHODS: A retrospective study involved 82 patients with acute renal failure admitted to dialysis in Ibn Al-Balady hospital for a period of 32 months from August 2011 to April 2014 . Data were collected from patients records and involved clinical parameters of the patients, causes of ARF , indications of PD ,complications of PD and the outcome of PD(deaths).RESULTS : The study involved 82 children of whom 47(57.3%) male ,with a mean age of 13 +19.5 months . Azotemia was presented in all patients (100%) with oliguria in 60(73.2%) or unuria in 26 pateints (31.7%) , volume overlaod in 32(39%) , encephalopathy in 28 pateints (32.9%). Sepsis was the most common cause of ARF in 32 pateints (39%) while gastroentritis in 16 pateints (19.5%) , glomerulonephritis in 10 pateints (12.2%) and hemolytic uremic syndrome ( HUS) in 9 pateints (11%). Peritonitis is the commenest complication of PD represents 33(40.2%) of pateints. The overall mortality was 32.9 % mostly related to septicemia (63%) and the presence of fluid overlaod, peritonitis,encephalopathy and unuria (66.7,66.7,63 and 59.3% ) respectivly.CONCLUSION : Peritoneal dialysis is the preferred modality of renal replacement therapy (RRT) for children with acute renal failure( ARF) because its simple and feasible especially neonates and young infants and hemodynamically unstable patients. Septicemia and severity of ARF are contributory factors to high mortality in pediatric ARF.Early detection and referral of patients at risk is of great value for reducing mortality.


Article
Renal Impairment After Valvular Heart Surgery in Adult

Author: Wadhah A. Mahbuba
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2008 Volume: 7 Issue: 4 Pages: 347-350
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Cardiac surgery can either induce acute renal failure or improve GFR by improving the cardiac performance. Acute renal shutdown (urine output <0.5ml/kg/hr.) is an uncommon but fatal complication which occurs in cases of insufficient cardiac function and may be accompanied with multi-organ failure. Acute renal failure (ARF) after open heart valve surgery occurs in about 8% of adult cardiac surgical patients with some preoperative renal impairment and in about 3-4% of patients with normal preoperative renal function test. This study was done to determine the frequency of acute renal shutdown after valvular open heart surgery and to detect any suggestive risk factors.METHODS:90 patients undergoing valve replacement (mitral and/ or aortic) were prospectively evaluated in three time periods: before, 24 hours after surgery and 48 hours after surgery. The association between preoperative, intra-operative and postoperative variables and the development of ARF was assessed thoroughly.RESULTS:Of the 90 consecutive patients 3 (3.49%) patients developed acute renal failure (serum creatinine>2.5 mg/dl) and 16 (18.6%) patients developed acute renal dysfunction (serum creatinine 1.6-2.4 mg/dl). The risk factors that were noted in the development of ARF were age, raised preoperative blood urea and creatinine, low cardiac output state, diabetes mellitus, oligurea, total cross clamp time total CPB time, and significant hypotension during the procedure or during intensive care unit (ICU) stay. Mortality rate for established ARF was extremely poor (50 %).CONCLUSION:Avoidance of this dangerous outcome looks better than trying to treat once it is fully established.


Article
Indications and complications of peritoneal dialysis in children with acute renal failure, a single center experience
موجبات ومضاعفات غسيل الكلى البريتوني في الأطفال الذين يعانون من فشل كلوي حاد، ,تجربة مركز واحد

Author: Nariman F. A.Azat أ.م.د. نريمان فهمي احمد عزت
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 / 24108057 Year: 2016 Volume: 58 Issue: 2 Pages: 126-131
Publisher: Baghdad University جامعة بغداد

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Abstract:Background: Peritoneal dialysis (PD) is the preferred and convenient treatment modality for acute renal failure (ARF) in children and hemodynamically unstable patients, because of its inherent advantages: technique can be initiated simply and quickly, no highly trained personnel nor expensive and complex apparatus are required and systemic anticoagulation is not needed.Objectives: is to highlight the role of peritoneal dialysis in management of children with acute renal failure and to determined its complications.Patients and methods: A retrospective study was carried out from 20th April 2012 till1st May 2014 ,on children with acute renal failure admitted to nephrology unit in Child Welfare Teaching Hospital and peritoneal dialysis was done for them in the acute intermittent peritoneal dialysis ward which was established since 2012 . Age ranged from one day up to fifteen years .Indications, complications of the procedure and outcome of recovery were recorded.Results: Fifty nine children with acute renal failure were enrolled in the present study 23(39%) female and 36(61%) male, their age ranged from (8 days-15 years ). congenital malformations of renal system 13 (22%), hemolytic uremic syndrome 10(16.9%), sepsis 7(11.9%) were the predominant causes of acute renal failure. Complications of dialysis were significantly low among studied patients 18.6%(p<0.001).The main dialysis related complication was catheter malfunction(45%). The incidence of peritonitis 1(9%)(P=0.01).Recovery of renal function after peritoneal dialysis found in 42 patients Survival rate among these patients was 97.6% (p<0.001) .Overall mortality was 22%. The most common cause of death was septicemia in (57%) of patients. Conclusions: Because of its simplicity and feasibility, acute PD is still an appropriate treatment choice for children with ARFKey words: acute renal failure, children, peritoneal dialysis

ملخص:خلفية: غسيل الكلى البريتوني (PD) هي طريقة العلاج المفضل والمناسب للفشل الكلوي الحادللاطفال والمرضى غير مستقر الدورة الدموية، بسبب مزاياها الكامنة: تقنية يمكن البدء بها ببساطة وبسرعة، والأفراد غير المدربين تدريبا عاليا اوليست مكلفة و لايتطلب استعمال جهاز، وليس هناك حاجة إلى منع تخثر الدم.الهدف من الدراسة: هو تسليط الضوء على دور غسيل الكلى البريتوني في التدبير العلاجي للأطفال الذين يعانون من الفشل الكلوي الحاد، وتحديد مضاعفاته.مرضى والطرق: أجريت دراسة استعادية عن الأطفال يعانون من الفشل الكلوي الحاد الذي تم القيام به لغسيل الكلى البريتوني لهم في مستشفى حماية الاطفال التعليمي من ال20 أبريل 2012 حتى 1 مايو 2014. تراوحت بين شهر واحد إلى اربعة عشر عاما. وسجلت جميع مضاعفات الإجراء ونتائج الانتعاش.النتائج: تم تسجيل 59 طفلا يعانون من الفشل الكلوي الحاد في هذه الدراسة (23) إناث و 36 ذكور) تتراوح أعمارهم من شهر-14 سنة). كانت تشوه خلقي من نظام الكلوي (22٪)، ومتلازمة التحلل الدموي البولي (16.9٪)، وتعفن الدم (11.9٪) الأسباب الغالبة للفشل الكلوي الحاد. وكانت مضاعفات الغسيل البريتوني منخفضة بشكل ملحوظ لدى المرضى درس 18.6٪ (P <0.001). وتتعلق غسيل الكلى الرئيسية التي أظهرتها الدراسة مضاعفات القسطرة عطل (45٪)، وحدوث التهاب الصفاق للذين يخضعون للغسيل البريتوني في دراستنا منخفض وبشكل كبير (P = 0.01.واستعادة وظيفة الكلى بعد الغسيل البريتوني وجدت في 42 مريضا ,معدل البقاء على قيد الحياة من بين هؤلاء المرضى 97.6 ٪ (P <0.001) وكانت نسبة الوفيات . 22٪. تم العثور على السبب الأكثر شيوعا للوفاة تسمم الدم في (57)%) من المرضى.الاستنتاجات: ونظرا لبساطته والجدوى، الغسيل البريتوني الحاد لا يزال كخيار العلاج المناسب للأطفال الذين يعانون من الفشل الكلوي الحادالكلمات الرئيسية: الفشل الكلوي الحاد، الأطفال، غسيل الكلى البريتوني

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