Acute Ostructive Renal Failure in Children (Literature Review with Their Own Сlinical Оbservations)

Abstract

Acute postrenal renal damage in children is rare and little known to practitioners. Our research includes 12 observations in children from 7 days to 12 years. 10 of 12 patients were with sus-pected hemolytic-uremic syndrome, and 2 babies with regurgitation syndrome. 7 patients had hypazotemia, and 5 experienced moderate increase in azotemia. The cause of the postrenal acute renal damage (ARD) in most children (10/12) was acute dismetabolic disorders against intoxication, hypovolemia, hyperthermia with obstruction of the urinary tract at the distal ureter level (8/12) or pelvioureteral articulation (2/12). In 1 case in 3-month-old baby ARD developed against nephrocandidosis, obstruction of the collecting system of kidneys by fungal masses. An-other patient a 7-day-old girl developed ARD against infravesical obstruction with presacral cystic involvement (Currarino syndrome). In all cases ultrasound helped to diagnose the cause of ARD. Echographically the majority of patients (9/12) had a moderate increase in kidney size, an echogenicity increase of the unexhausted parenchyma, a moderate calices-pelvis system di-latation, and a presence of echodense inclusions in the urinary tract. A Doppler ultrasound test of renal blood flow showed that relative safety of the intracranial vascular pattern, a moderate increase in the resistive characteristics of arterial renal blood flow and an increase in the rate of venous outflow were typical. We could rapidly provide adequate urine outflow (with a urethral catheter, ureter stenting, nephrostomy) and it allowed to normalize azotemia and to restore diu-resis within 1-1,5 days in all cases. 2 children needed short-term renal replacement. All the children recovered.