ABSTRACT
Children in a pediatric intensive care unit (PICU) setting develop a wide range of metabolic disturbances as well as acute renal failure (ARF), and pediatric nephrologists are closely involved in all aspects of diagnosis and management of these patients, beyond merely providing renal replacement therapy (RRT). Despite advances in pediatric critical care, ARF remains a significant source of morbidity for children in the PICU. The causes of ARF in children differ importantly from those in adults.1,2 Primary renal disease accounts for a larger share of ARF in the PIGU than is seen in adults; sepsis and multiorgan failure are proportionally less common in children. The causes of pediatric ARF also differ between industrialized and nonindustrialized countries. Hemolytic uremic syndrome (HUS) and glomerulonephritis (GN) appear to be more common and more severe in developing countries, whereas ARF secondary to other complicated medical illnesses is more likely to occur in industrialized nations which offer more intensive therapies. The clinical picture of ARF may also result from an acute presentation of previously asymptomatic end-stage renal disease or congenital urologic abnormality. Survival of children who require dialysis in the PICU is superior to that of adults and is estimated at approximately 65% in single-center series; in addition, the likelihood of recovery of renal function is high.3
