ABSTRACT
Introduction The successful management of children with renal failure can only be achieved if the practitioner has a thorough understanding of the development of normal renal function and the alterations that occur to metabolic balance during childhood. The kidney in the newborn is immature, buffering capacity is reduced and the ability to conserve and excrete sodium is limited. Even when quite severe renal disease is present, serum biochemistry can be normal at birth because the mother maintains fetal homeostasis. When a severely affected infant is born, especially when multiple defects are present, the ethical and moral implications of attempting renal replacement therapy can be considerable. A thorough working knowledge of the expected prognosis is required prior to commencing treatment because the mortality rate for both acute and chronic renal failure in infants remains high.
